Provider Demographics
NPI:1720416761
Name:WELCH, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16938 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4354
Mailing Address - Country:US
Mailing Address - Phone:305-378-0888
Mailing Address - Fax:305-378-0807
Practice Address - Street 1:16938 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4354
Practice Address - Country:US
Practice Address - Phone:305-378-0888
Practice Address - Fax:305-378-0807
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1769171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator