Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | W0718780 | MS |
NPI | 1003907460 |
---|---|
Provider Name | Dr. Patrick E Weldon |
First Address | Jackson, MS 39204 |
Second Address | Jackson, MS 39204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05236809 | (05) | MS |
I32875 | (02) | MS |