Provider Demographics
NPI:1588765747
Name:WALD, TINA GAY (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:GAY
Last Name:WALD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:GERIATRICS AND EXTENDED CARE
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-742-8387
Mailing Address - Fax:214-857-1712
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:GERIATRICS AND EXTENDED CARE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:214-857-1712
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXK9451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine