Provider Demographics
NPI:1528203320
Name:WELDON, PHYLLIS CAROLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:CAROLINE
Last Name:WELDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WILD HORSE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3654
Mailing Address - Country:US
Mailing Address - Phone:415-898-6402
Mailing Address - Fax:
Practice Address - Street 1:144 WILD HORSE VALLEY RD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3654
Practice Address - Country:US
Practice Address - Phone:415-898-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine