Provider Demographics
NPI:1215961487
Name:WALDMANN, GEORGE (M D)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:WALDMANN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 NE 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1977
Mailing Address - Country:US
Mailing Address - Phone:503-231-7385
Mailing Address - Fax:
Practice Address - Street 1:1800 SW 1ST AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5333
Practice Address - Country:US
Practice Address - Phone:503-944-8810
Practice Address - Fax:503-944-8814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine