# WELAKA CLINIC INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184651168
- **Authorized official:** GARY BUCKMAN (ADMINISTRATOR)
- **Authorized official phone:** (386) 467-3171

## Contact information

- **Practice address:** 405 ELM ST, WELAKA, FL 32193-1110
- **Practice address phone:** (386) 467-3171
- **Practice address fax:** (386) 467-3174
- **Mailing address:** PO BOX 1110, WELAKA, FL 32193-1110
- **Mailing address phone:** (386) 467-3171
- **Mailing address fax:** (386) 467-3174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OS0006099 | FL | — |
| 207Q00000X | Family Medicine Physician | OS8101 | FL | — |
| 207R00000X | Internal Medicine Physician | 17713 | FL | — |
| 207R00000X | Internal Medicine Physician | ME54534 | FL | — |
| 207V00000X | Obstetrics & Gynecology Physician | ME0059459 | FL | — |
| 207V00000X | Obstetrics & Gynecology Physician | ME75694 | FL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | ME85684 | FL | — |

## Other

- **Enumeration date:** 06/27/2006
- **Last updated:** 09/11/2025