1386725257 NPI number — DR. BRENDA JOY WELDY DPM

Table of content: DR. BRENDA JOY WELDY DPM (NPI 1386725257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386725257 NPI number — DR. BRENDA JOY WELDY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELDY
Provider First Name:
BRENDA
Provider Middle Name:
JOY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386725257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1902 SERENITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PFLUGERVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78660-8144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-589-1132
Provider Business Mailing Address Fax Number:
512-251-3370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 SERENITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660-8144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-589-1132
Provider Business Practice Location Address Fax Number:
512-251-3370
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E4667 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 1797 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8J7624 . This is a "HOME FOOT CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J7623 . This is a "AAMPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00417476 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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