Provider Demographics
NPI:1619573490
Name:MATTHEW WELTER MD
Entity Type:Organization
Organization Name:MATTHEW WELTER MD
Other - Org Name:MATTHEW WELTER M.D.,P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-757-8943
Mailing Address - Street 1:1915 E 13000 N
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:UT
Mailing Address - Zip Code:84320-2130
Mailing Address - Country:US
Mailing Address - Phone:435-757-8943
Mailing Address - Fax:
Practice Address - Street 1:1219 N 400 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2321
Practice Address - Country:US
Practice Address - Phone:435-932-2025
Practice Address - Fax:435-215-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty