Provider Demographics
NPI:1518907435
Name:WELCH, ANDREW JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACKSON
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 1:1950 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3250
Mailing Address - Country:US
Mailing Address - Phone:702-737-3438
Mailing Address - Fax:702-369-9898
Practice Address - Street 1:1950 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3250
Practice Address - Country:US
Practice Address - Phone:702-737-3438
Practice Address - Fax:702-369-9898
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3713207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V001717OtherCHAMPUS
NV002002192Medicaid
C96692Medicare UPIN