Provider Demographics
NPI:1639285034
Name:WELCH, JON E (M D)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:E
Last Name:WELCH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 130TH AVE NE
Mailing Address - Street 2:STE 220
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1718
Mailing Address - Country:US
Mailing Address - Phone:425-777-7486
Mailing Address - Fax:
Practice Address - Street 1:2320 130TH AVE NE
Practice Address - Street 2:STE 220
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1718
Practice Address - Country:US
Practice Address - Phone:425-777-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60424819207KA0200X, 207KA0200X
WV21284207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59-06067Medicaid
NCH98387Medicare UPIN
NC2059035Medicare PIN