Provider Demographics
NPI:1457380933
Name:WELTON, RICHARD CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CRAIG
Last Name:WELTON
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:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-486-0114
Mailing Address - Fax:509-486-0170
Practice Address - Street 1:106 S WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9286
Practice Address - Country:US
Practice Address - Phone:509-486-0114
Practice Address - Fax:509-486-0170
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000343559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11936OtherLABOR & INDUSTRIES
WA8220691Medicaid
WA11936OtherLABOR & INDUSTRIES