Provider Demographics
NPI:1093924375
Name:WELDON, DERIK T (MD)
Entity Type:Individual
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First Name:DERIK
Middle Name:T
Last Name:WELDON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1450 NW 6035
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-6035
Mailing Address - Country:US
Mailing Address - Phone:800-634-4064
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:166 19TH STREET SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2154
Practice Address - Country:US
Practice Address - Phone:320-251-0609
Practice Address - Fax:320-251-3806
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-11-08
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Provider Licenses
StateLicense IDTaxonomies
MN453082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology