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NPI Code Detail

MEDICARE: MR. WEIDONG SU PA-C

MEDICARE: MR. WEIDONG SU PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9106187FL

General Provider Information

NPI Number : 1306122973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WEIDONG SU PA-C
Provider Business Mailing Address
First Line : 8923 HAMPTON LANDING DR E
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4585
Country : US
Telephone Number : 904-349-6856
Fax Number : 904-757-1220
Provider Business Practice Location Address
First Line : 11565 N MAIN ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-4002
Country : US
Telephone Number : 904-757-2811
Fax Number : 904-757-0191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2011
Last Update Date : 12/01/2025

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Directions to “ MR. WEIDONG SU PA-C” Practice Location

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