Provider Demographics
NPI:1184611014
Name:WELSHONS, ROBERT M (PAC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:WELSHONS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 KIMBALL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5047
Mailing Address - Country:US
Mailing Address - Phone:319-272-2112
Mailing Address - Fax:319-272-2107
Practice Address - Street 1:2055 KIMBALL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5047
Practice Address - Country:US
Practice Address - Phone:319-272-2112
Practice Address - Fax:319-272-2107
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6616Medicare ID - Type Unspecified
IA598184Medicare UPIN