Healthcare Provider Details

I. General information

NPI: 1538768833
Provider Name (Legal Business Name): JAMES BLAKE WELDON IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 100334 BOX 1
FPO AE
09579-3400
US

IV. Provider business mailing address

USS NEW MEXICO SSN 779 UNIT 334
APO AA
09579
US

V. Phone/Fax

Practice location:
  • Phone: 207-438-3231
  • Fax:
Mailing address:
  • Phone: 207-438-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: