Basic Information
| Provider Information | |||||||||
| NPI: | 1497737027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDMAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ROGER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11086 SE OAK ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972226692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035572020 | ||||||||
| FaxNumber: | 5033445110 | ||||||||
| Practice Location | |||||||||
| Address1: | 10819 SE STARK ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972163161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552291 | ||||||||
| FaxNumber: | 5032521797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD10055 | OR | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 241414 | 05 | OR | MEDICAID |