Provider Demographics
NPI:1083892830
Name:DR. LAURENCE E WELKER, APMC
Entity Type:Organization
Organization Name:DR. LAURENCE E WELKER, APMC
Other - Org Name:LAURENCE E WELKER, DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-227-0810
Mailing Address - Street 1:915 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2103
Mailing Address - Country:US
Mailing Address - Phone:318-227-0810
Mailing Address - Fax:318-227-8323
Practice Address - Street 1:915 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2103
Practice Address - Country:US
Practice Address - Phone:318-227-0810
Practice Address - Fax:318-227-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD129R261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1928577Medicaid
LA5801780001Medicare NSC
LAT96925Medicare UPIN
LA1928577Medicaid