Provider Demographics
NPI:1083003040
Name:WELDON MEDICAL PRODUCTS INC.
Entity Type:Organization
Organization Name:WELDON MEDICAL PRODUCTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:904-237-5648
Mailing Address - Street 1:36 S COLLEGE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2439
Mailing Address - Country:US
Mailing Address - Phone:904-472-5374
Mailing Address - Fax:904-259-0579
Practice Address - Street 1:36 S COLLEGE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2439
Practice Address - Country:US
Practice Address - Phone:904-472-5374
Practice Address - Fax:904-259-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED 228335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL224L00000XOtherCMS- TAXONOMY CODE FOR 'PEDORTHIST'