Provider Demographics
NPI:1689954620
Name:WELSH, DALE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:WELSH
Suffix:
Gender:M
Credentials:PA-C
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 71766
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1766
Mailing Address - Country:US
Mailing Address - Phone:206-696-2580
Mailing Address - Fax:719-526-8883
Practice Address - Street 1:1717 WEST COWLES STREET
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5903
Practice Address - Country:US
Practice Address - Phone:907-451-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK363A00000X
AZ71482084P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant