Provider Demographics
NPI:1578665725
Name:WELLING, ERIC C (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:WELLING
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:PO BOX 840857
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0857
Mailing Address - Country:US
Mailing Address - Phone:725-204-4632
Mailing Address - Fax:702-805-0307
Practice Address - Street 1:7160 RAFAEL RIVERA WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-5395
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:702-209-2064
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173723-1205207L00000X
CAA48457207L00000X
NV21971207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2090168OtherUNITED HEALTHCARE
UT73549OtherPEHP
AZ828527Medicaid
UT107006520102OtherIHC
UT453OtherHEALTHY U
UT870545614WE2OtherEDUCATORS MUTUAL
UTPRA01662OtherMOLINA
UTQM0000075886OtherALTIUS
UT21041OtherDESERET MUTUAL
WY119018100Medicaid
UT1502954OtherUMWA
ID001609400Medicaid
NV100502002Medicaid
UTP00034358Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NV100502002Medicaid
ID001609400Medicaid