Provider Demographics
NPI:1336196161
Name:WELSH, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:WELSH
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 1:110 N 29TH ST
Mailing Address - Street 2:STE. 301
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4461
Mailing Address - Country:US
Mailing Address - Phone:402-844-8284
Mailing Address - Fax:402-644-7505
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:STE. 301
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4461
Practice Address - Country:US
Practice Address - Phone:402-844-8284
Practice Address - Fax:402-644-7505
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18117207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01005OtherBCBSNE
NEP00193879OtherRR
NEP00193879OtherRR
NE01005OtherBCBSNE