Provider Demographics
NPI:1760437313
Name:WELKER, WESTON J (MD)
Entity Type:Individual
Prefix:DR
First Name:WESTON
Middle Name:J
Last Name:WELKER
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 1:600 WHITESPORT CIR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6495
Mailing Address - Country:US
Mailing Address - Phone:256-882-2003
Mailing Address - Fax:256-882-7115
Practice Address - Street 1:185 CHATEAU DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTSVILLE
Practice Address - State:ALABAMA
Practice Address - Zip Code:35801
Practice Address - Country:UM
Practice Address - Phone:256-705-4402
Practice Address - Fax:256-705-4630
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13209174400000X
ALMD.13209207P00000X
AL00013209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557052OtherMEDICARE
AL009936914Medicaid
AL4004082OtherAETNA
AL51537670OtherBCBS
AL009911231Medicaid
AL51534290OtherBCBS
AL051541754OtherBCBS
AL051559151Medicare PIN
AL009911231Medicaid