Provider Demographics
NPI:1831287564
Name:WELDON, SCOTT T (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:WELDON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E ROWAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1212
Mailing Address - Country:US
Mailing Address - Phone:509-483-3155
Mailing Address - Fax:509-487-3270
Practice Address - Street 1:42 E ROWAN AVE STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1212
Practice Address - Country:US
Practice Address - Phone:509-483-3155
Practice Address - Fax:509-483-3270
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60490220363A00000X
WI2059-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60490220OtherSTATE LICENSE
WI2059-023OtherLICENSE