Provider Demographics
NPI:1720027204
Name:WELCH, LINDA (DO, PA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:DO, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 PERRIN BEITEL RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2534
Mailing Address - Country:US
Mailing Address - Phone:210-946-5633
Mailing Address - Fax:
Practice Address - Street 1:11312 PERRIN BEITEL RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2534
Practice Address - Country:US
Practice Address - Phone:210-946-5633
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SZ90Medicare ID - Type Unspecified
TXD97393Medicare UPIN