Provider Demographics
NPI:1437157484
Name:WELCH, BARRY PETERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:PETERSON
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 1:424 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9318
Mailing Address - Country:US
Mailing Address - Phone:307-587-5538
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9318
Practice Address - Country:US
Practice Address - Phone:307-587-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5652A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110675900Medicaid
WY180023255OtherRAILROAD MEDICARE
WY306944OtherBLUE CROSS BLUE SHIELD
WYW9546Medicare PIN
WY110675900Medicaid