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General NPI Number Information
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NPI Number | 1184651168
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Entity Type | Organization
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Legal Business Name | WELAKA CLINIC INC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 405 ELM ST
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City | WELAKA
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State | FL
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Zip | 32193-1110
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Country | US
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Telephone | 386-467-3171
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Fax | 386-467-3174
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Provider Business Mailing Address
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Address Line | PO BOX 1110
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City | WELAKA
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State | FL
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Zip | 32193-1110
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Country | US
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Telephone | 386-467-3171
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Fax | 386-467-3174
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GARY BUCKMAN
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Credential |
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Telephone | 386-467-3171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS0006099
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8101
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 17713
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME54534
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME0059459
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME85684
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME75694
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License Number State | FL
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