Provider Demographics
NPI:1285720888
Name:WELDEN, STEPHEN WARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WARD
Last Name:WELDEN
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 1:18944 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4964
Mailing Address - Country:US
Mailing Address - Phone:813-386-0618
Mailing Address - Fax:813-386-0622
Practice Address - Street 1:18944 N DALE MABRY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4964
Practice Address - Country:US
Practice Address - Phone:813-386-0618
Practice Address - Fax:813-386-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 35994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30477Medicaid
FLE19696Medicare UPIN
FL30477Medicaid