Provider Demographics
NPI:1366473530
Name:WELCH, BERT A III (MD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:A
Last Name:WELCH
Suffix:III
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 1:2550 FLOWOOD DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9303
Mailing Address - Country:US
Mailing Address - Phone:601-933-9521
Mailing Address - Fax:601-933-9525
Practice Address - Street 1:2550 FLOWOOD DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9303
Practice Address - Country:US
Practice Address - Phone:601-933-9521
Practice Address - Fax:601-933-9525
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10749207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0115745Medicaid
MS0115745Medicaid