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General NPI Number Information
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NPI Number | 1730379066
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Entity Type | Organization
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Legal Business Name | WELDON MEDICAL CLINIC PA
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 3800 CAMP BOWIE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76107-3356
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Country | US
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Telephone | 817-348-8000
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Fax | 817-348-8003
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Provider Business Mailing Address
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Address Line | 3800 CAMP BOWIE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76107-3356
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Country | US
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Telephone | 817-348-8000
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Fax | 817-348-8003
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BILL E WELDON
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Credential | D.O.
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Telephone | 817-348-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | F4669
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License Number State | TX
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