Healthcare Provider Details

I. General information

NPI: 1265663942
Provider Name (Legal Business Name): JAMES ERIC WELDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 LAKEVIEW DR
SOUR LAKE TX
77659-9237
US

IV. Provider business mailing address

1310 LAKEVIEW DR
SOUR LAKE TX
77659-9237
US

V. Phone/Fax

Practice location:
  • Phone: 409-753-2813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberBWO702123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: