Provider Demographics
NPI:1821058728
Name:WELCH, JOANN SAMPSON (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:SAMPSON
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:SAMPSON
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4739 BYRON CIR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6319
Mailing Address - Country:US
Mailing Address - Phone:972-650-0844
Mailing Address - Fax:
Practice Address - Street 1:7212 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5761
Practice Address - Country:US
Practice Address - Phone:972-618-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166051601Medicaid
TX8B9948Medicare ID - Type Unspecified
TX166051601Medicaid