Provider Demographics
NPI:1790828440
Name:LAURIE WELTON DO PA
Entity Type:Organization
Organization Name:LAURIE WELTON DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-299-7009
Mailing Address - Street 1:3735 11TH CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4844
Mailing Address - Country:US
Mailing Address - Phone:772-299-7009
Mailing Address - Fax:772-562-7138
Practice Address - Street 1:3735 11TH CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4844
Practice Address - Country:US
Practice Address - Phone:772-299-7009
Practice Address - Fax:772-562-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8950207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD7741OtherRAILROAD
FLP00250143OtherRAILROAD
FLK8272Medicare PIN
FLDD7741OtherRAILROAD