Provider Demographics
NPI:1215932074
Name:WALDRON, DEBRA BETH (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:BETH
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4107
Mailing Address - Fax:319-356-3715
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4107
Practice Address - Fax:319-356-3715
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45397208000000X
NJ25MA04720100208000000X
MA226658208000000X
IA38049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN634930700Medicaid
IAI0923126Medicare PIN
MN634930700Medicaid