Provider Demographics
NPI:1861438210
Name:WALDROP, KEVIN L (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:WALDROP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 GADSDEN HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3266
Mailing Address - Country:US
Mailing Address - Phone:205-655-1114
Mailing Address - Fax:205-661-3585
Practice Address - Street 1:1960 GADSDEN HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-4200
Practice Address - Country:US
Practice Address - Phone:205-655-1114
Practice Address - Fax:205-661-3585
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2700040OtherUHC PROVIDER NUMBER
AL03100OtherBC PROVIDER NUMBER
ALU85192Medicare UPIN
AL051503100Medicare ID - Type Unspecified