Provider Demographics
NPI:1316063423
Name:COLLINS, WELDON EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:WELDON
Middle Name:EDWARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3070 COLLEGE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4688
Mailing Address - Country:US
Mailing Address - Phone:409-835-1333
Mailing Address - Fax:409-835-2629
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4688
Practice Address - Country:US
Practice Address - Phone:409-835-1333
Practice Address - Fax:409-835-2926
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9316207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114648201Medicaid
TX114648201Medicaid
TXD97286Medicare UPIN