MR. JEREMY GAYLON WALDIE (NPI# 1043546534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043546534 |
| Entity Type | Individual |
| Full Name | MR. JEREMY GAYLON WALDIE |
| Credential | PA-C |
| Practice Address |
374 Owens St Se Salem OR 97302-4183 |
| Practice Telephone | 5033991400 |
| Practice Fax Number | 5033991406 |
| Mailing Telephone | 5033991400 |
| Mailing Fax Number | 5033991406 |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2020-02-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA165500 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA60120298 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 50071199 | 05 |
| Street Address |
374 OWENS ST SE |
| City | SALEM |
| State | OR |
| Zip Code | 97302-4183 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861479396 | Evelin Dacker | Family Medicine | 374 Owens St Se, Salem, OR 97302-4145 | 2005-12-27 |
| 1184086209 | Vida Family Medicine | Counselor | 374 Owens St Se, Salem, OR 97302-4183 | 2016-03-28 |
| 1801291067 | Maansi Family Health Center | Naturopath | 374 Owens St Se, Salem, OR 97302-4183 | 2014-10-30 |
| 1457790826 | Groundswell Integrative Healthcare Inc. | Family Medicine | 374 Owens St Se, #100, Salem, OR 97302-4183 | 2013-06-19 |
| 1235305020 | Andrew N Davis | Counselor | 374 Owens St Se, Salem, OR 97302-4183 | 2008-05-01 |
| 1598965238 | Ann M Gould | Physician Assistant | 374 Owens St Se, Ste 100, Salem, OR 97302-4183 | 2007-07-20 |
| 1356554752 | Nancy Ludwig | Dietitian, Registered | 374 Owens St Se, Suite 100, Salem, OR 97302 | 2007-05-08 |
| 1598834301 | Karen Bolinger Jones Shorr | Naturopath | 374 Owens St Se, Ste 100, Salem, OR 97302 | 2006-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699374660 | Sarah Ilana Katz | Physician Assistant | 11a Laurel St, Salem, MA 01970-4657 | 2020-10-21 |
| 1306444641 | Zachary Wright | Physician Assistant | 11 Harley Ln, Salem, NH 03079-2888 | 2020-10-09 |
| 1174132195 | Andrew Yosim | Physician Assistant | 1750 Pexton Ave, Salem, VA 24153-4108 | 2020-07-27 |
| 1689202269 | Adam Joyce | Physician Assistant | 1005 Meadowrun Ct, Salem, VA 24153-6687 | 2020-03-30 |
| 1417504085 | Alexis Marie Biewend | Physician Assistant | 1645 Waln Dr Se Apt 263, Salem, OR 97306-2963 | 2019-08-19 |
| 1497309322 | Lindsey Ann Castleberry | Physician Assistant | 1111 Meadow Sage Cir, Salem, UT 84653-5578 | 2019-07-29 |
| 1134773450 | Jillian Netland | Physician Assistant | 6507 Lipscomb St Se, Salem, OR 97317-9513 | 2019-07-25 |
| 1457827354 | Gretchen Amrien | Physician Assistant | 4 Bypass Rd Ste 201, Salem, NJ 08079-2053 | 2018-10-17 |
| 1649751934 | Matthew Hansen | Physician Assistant | 875 Oak St. Se Ste 5020, Salem, OR 97301 | 2018-08-24 |
| 1487152948 | Jessica Lynn Brooks | Physician Assistant | 875 Oak St Se Ste 5060, Salem, OR 97301 | 2018-01-30 |
| Find all providers in SALEM | ||||
Please comment or provide details below to improve the information on MR. JEREMY GAYLON WALDIE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.