Basic Information
| Provider Information | |||||||||
| NPI: | 1457356610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADDLE | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037854700 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037854700 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | K6400 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | DR.0056738 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1457356610 | 05 | CO | MEDICAID | 104199806 | 05 | TX | MEDICAID | 104199803 | 05 | TX | MEDICAID | P01446868 | 01 | TX | RR | OTHER | 8EH613 | 01 | TX | BCBS | OTHER |