Healthcare Provider Details

I. General information

NPI: 1295726222
Provider Name (Legal Business Name): WILLIAM ELLIOT WEDDLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 OAKWOOD ST
BEDFORD VA
24523-1213
US

IV. Provider business mailing address

77 HEAH TON LN
LEXINGTON VA
24450-7427
US

V. Phone/Fax

Practice location:
  • Phone: 540-586-2441
  • Fax:
Mailing address:
  • Phone: 540-261-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101029423
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: