Provider Demographics
NPI:1417146283
Name:WELCH, PATRICK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
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 1:200 BEAULLIEU DRIVE, BUILDING 1
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7230
Mailing Address - Country:US
Mailing Address - Phone:337-289-6808
Mailing Address - Fax:337-289-6807
Practice Address - Street 1:200 BEAULLIEU DRIVE, BUILDING 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-289-6808
Practice Address - Fax:337-289-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD12979R207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1552704Medicaid
LA5E439Medicare PIN
LA1552704Medicaid