Provider Demographics
NPI:1013143692
Name:WELKE, BRETT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JAMES
Last Name:WELKE
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 1:2730 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3302
Mailing Address - Country:US
Mailing Address - Phone:337-794-1545
Mailing Address - Fax:
Practice Address - Street 1:2157 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1405
Practice Address - Country:US
Practice Address - Phone:347-824-8065
Practice Address - Fax:224-235-4652
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1291922085R0202X
NY2903452085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology