Provider Demographics
NPI:1720041924
Name:WALDROUP, ANTHONY WAYNE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:WAYNE
Last Name:WALDROUP
Suffix:
Gender:
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 1:530 N MONTE VISTA ST STE A
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4675
Mailing Address - Country:US
Mailing Address - Phone:580-310-9510
Mailing Address - Fax:580-436-4447
Practice Address - Street 1:530 N MONTE VISTA ST STE A
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4675
Practice Address - Country:US
Practice Address - Phone:580-310-9510
Practice Address - Fax:580-436-4447
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202202083P0500X, 207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine