Provider Demographics
NPI:1003907460
Name:WELDON, PATRICK E (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:E
Last Name:WELDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1860 CHADWICK DRIVE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204
Mailing Address - Country:US
Mailing Address - Phone:601-376-2004
Mailing Address - Fax:601-376-2006
Practice Address - Street 1:1860 CHADWICK DRIVE
Practice Address - Street 2:SUITE 258
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204
Practice Address - Country:US
Practice Address - Phone:601-376-2004
Practice Address - Fax:601-376-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSW07187802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05236809Medicaid
MS05236809Medicaid
MSI32875Medicare UPIN