Provider Demographics
NPI:1902855646
Name:WELP, MARY LUCILLE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUCILLE
Last Name:WELP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 BRYAN PL
Mailing Address - Street 2:STE#200
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7147
Mailing Address - Country:US
Mailing Address - Phone:972-775-4132
Mailing Address - Fax:972-775-4620
Practice Address - Street 1:2230 BRYAN PL
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7147
Practice Address - Country:US
Practice Address - Phone:972-775-4132
Practice Address - Fax:972-775-4620
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133973109Medicaid
TX8CG136OtherBLUE CROSS
TXB27488Medicare UPIN
TX8CG136OtherBLUE CROSS