Jerome R Waldbaum, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD00020538 Issued in WA

Practice address

4225 Hoyt Ave
Suite a
Everett, WA 98203-2351

Phone

(425) 259-3122

NPI assigned

Jun 20, 2006

Last updated

Jan 13, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200182400000",
    "number": "1689610602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 HOYT AVE",
            "address_2": "SUITE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032351",
            "telephone_number": "425-259-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 HOYT AVE",
            "address_2": "SUITE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032351",
            "telephone_number": "425-259-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDBAUM",
        "first_name": "JEROME",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD00020538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "0037731",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "MD00020538",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8483505",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores, Inc. (Vision Center 30-5195)
• Toni Lee Walbrun, PEER
• Patricia Louise Walcott, R.N.
• Magdalena M Walczak, MD
• Kaitlyn Wald, MD
• Michael Alan Walde, RPH
• Christene Waldman, LCSW
• Jeffry Waldrop, D.C.
• Andrea Waldschmidt, LMHC
• Walgreen Co (Walgreens #05598)

• Gastroenterology Physician in Everett, WA
• Providers in Everett, WA by specialty
• Gastroenterology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.