Provider Demographics
NPI:1285639658
Name:WELDON, DONALD C
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:WELDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2003
Mailing Address - Country:US
Mailing Address - Phone:402-228-3545
Mailing Address - Fax:402-228-3826
Practice Address - Street 1:1201 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2003
Practice Address - Country:US
Practice Address - Phone:402-228-3545
Practice Address - Fax:402-228-3826
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-02-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
NE16679207R00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00733OtherBLUE CROSS BLUE SHIELD
NE47071415401Medicaid
NE00733OtherBLUE CROSS BLUE SHIELD
NEB90875Medicare UPIN