Provider Demographics
NPI:1235122763
Name:WELSH, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:WELSH
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:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-1268
Mailing Address - Country:US
Mailing Address - Phone:360-829-0625
Mailing Address - Fax:360-829-9860
Practice Address - Street 1:305 N RIVER AVE
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-8978
Practice Address - Country:US
Practice Address - Phone:360-829-0625
Practice Address - Fax:360-829-9860
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA26055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1300979Medicaid
WAAW218S317OtherDEA
WAAW218S317OtherDEA
WA1300979Medicaid