Provider Demographics
NPI:1194140582
Name:A.M. WALDRON MD, LTD.
Entity type:Organization
Organization Name:A.M. WALDRON MD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-636-7313
Mailing Address - Street 1:5595 KIETZKE LN
Mailing Address - Street 2:STE. 112
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3029
Mailing Address - Country:US
Mailing Address - Phone:775-636-7313
Mailing Address - Fax:775-657-6129
Practice Address - Street 1:5595 KIETZKE LN
Practice Address - Street 2:STE. 112
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3029
Practice Address - Country:US
Practice Address - Phone:775-636-7313
Practice Address - Fax:775-657-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV101492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1477612240Medicaid