Provider Demographics
NPI:1386826626
Name:EAR NOSE THROAT AND ALLERGY CENTER PLLC
Entity Type:Organization
Organization Name:EAR NOSE THROAT AND ALLERGY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMINE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-341-5088
Mailing Address - Street 1:PO BOX 3500
Mailing Address - Street 2:DEPT. 607
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-3500
Mailing Address - Country:US
Mailing Address - Phone:918-341-5088
Mailing Address - Fax:
Practice Address - Street 1:1715 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3056
Practice Address - Country:US
Practice Address - Phone:918-341-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3797207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty