Provider Demographics
NPI:1750445458
Name:WELCH, TOM (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1312
Mailing Address - Country:US
Mailing Address - Phone:205-733-1733
Mailing Address - Fax:205-733-1733
Practice Address - Street 1:5608 FAIRWAY CT
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1312
Practice Address - Country:US
Practice Address - Phone:205-733-1733
Practice Address - Fax:205-733-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL12268208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC74319Medicare UPIN