Provider Demographics
NPI:1124130190
Name:KUNKEL, WELDON LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:WELDON
Middle Name:LOUIS
Last Name:KUNKEL
Suffix:
Gender:M
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:PO BOX 2589
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-2589
Mailing Address - Country:US
Mailing Address - Phone:254-751-4146
Mailing Address - Fax:254-751-4283
Practice Address - Street 1:6901 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-751-4146
Practice Address - Fax:254-751-4283
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXBE1006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX873801OtherBC BS
TX873801Medicare ID - Type Unspecified
TX873801OtherBC BS