Provider Demographics
NPI:1609347236
Name:WELCH PRIMARY CARE
Entity Type:Organization
Organization Name:WELCH PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-588-5835
Mailing Address - Street 1:2601 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-6246
Mailing Address - Country:US
Mailing Address - Phone:850-588-5835
Mailing Address - Fax:
Practice Address - Street 1:2601 THOMAS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-6246
Practice Address - Country:US
Practice Address - Phone:850-588-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty