Provider Demographics
NPI:1225027097
Name:WELCH, CHARLES G (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:449 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2232
Mailing Address - Country:US
Mailing Address - Phone:307-754-4559
Mailing Address - Fax:307-754-7733
Practice Address - Street 1:1613 STAMPEDE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4710
Practice Address - Country:US
Practice Address - Phone:307-587-9800
Practice Address - Fax:307-587-9830
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY6582A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116620400Medicaid
WY315520OtherBLUE CROSS BLUE SHIELD
WY311069OtherBLUE CROSS BLUE SHIELD
WY020050984OtherRAILROAD MEDICARE
WY315520OtherBLUE CROSS BLUE SHIELD
WY020050984OtherRAILROAD MEDICARE
WY311069OtherBLUE CROSS BLUE SHIELD