Provider Demographics
NPI:1275622110
Name:DARA J WELBORN MD PC
Entity Type:Organization
Organization Name:DARA J WELBORN MD PC
Other - Org Name:CORNERSTONE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-269-6345
Mailing Address - Street 1:10001 S EASTERN AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3907
Mailing Address - Country:US
Mailing Address - Phone:702-269-6345
Mailing Address - Fax:702-269-9422
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-269-6346
Practice Address - Fax:702-269-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101796Medicare ID - Type Unspecified