Provider Demographics
NPI:1942207253
Name:WEILAND, JASON ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:WEILAND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24237 474TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-6120
Mailing Address - Country:US
Mailing Address - Phone:605-212-5941
Mailing Address - Fax:605-205-7612
Practice Address - Street 1:24237 474TH AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-6120
Practice Address - Country:US
Practice Address - Phone:605-212-5941
Practice Address - Fax:605-428-3315
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD179213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDV03578Medicare UPIN