Healthcare Provider Details

I. General information

NPI: 1942207253
Provider Name (Legal Business Name): JASON ANDREW WEILAND D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24237 474TH AVE
DELL RAPIDS SD
57022-6120
US

IV. Provider business mailing address

24237 474TH AVE
DELL RAPIDS SD
57022-6120
US

V. Phone/Fax

Practice location:
  • Phone: 605-212-5941
  • Fax: 605-428-3315
Mailing address:
  • Phone: 605-212-5941
  • Fax: 605-205-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number179
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number179
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: