Provider Demographics
NPI:1346291796
Name:WELCH, KERRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:D
Last Name:WELCH
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 1:120 N 1220 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2946
Mailing Address - Country:US
Mailing Address - Phone:801-756-5241
Mailing Address - Fax:801-756-9102
Practice Address - Street 1:120 N 1220 E
Practice Address - Street 2:#15
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-756-5241
Practice Address - Fax:801-756-9102
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT870467383173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQMXEF02544OtherALTIUS
UT0244033 01OtherUNITED HEALTH CARE
UT107006233101OtherSELECT HEALTH
UT260025OtherCIGNA
UT6198OtherPEHP
UT60054OtherAETNA
UT020053056OtherMEDICARE RAILROAD
UT6198OtherPEHP