Provider Demographics
NPI:1457545345
Name:WELCH, JUDSON STEWART (PA)
Entity Type:Individual
Prefix:MR
First Name:JUDSON
Middle Name:STEWART
Last Name:WELCH
Suffix:
Gender:M
Credentials:PA
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-028OtherTRICARE
TXP00431993OtherRAILROAD MEDICARE
TX00T71UOtherBCBS
TX188998204Medicaid
TX188998205Medicaid
TX188998206Medicaid
TX8Y2728OtherBLUE CROSS
TX75-0818167-048OtherTRICARE
TX188998203Medicaid
TX75-2616977-001OtherTRICARE
TX75-0818167-015OtherTRICARE
TX75-2616977-002OtherTRICARE
TXP01069699OtherRAIL ROAD
TX75-0818167-022OtherTRICARE
TX75-0818167-044OtherTRICARE
TX75-1976930-015OtherTRICARE
TX874N75OtherBCBS
TX876N24OtherBCBS
TX8900NCOtherBCBS
TXP01276459OtherRAIL ROAD
TXP01304491OtherRAIL ROAD
TX876N24OtherBCBS
TX75-1976930-015OtherTRICARE
TX75-2616977-001OtherTRICARE
TX188998204Medicaid
TX188998205Medicaid
TX188998206Medicaid
TXP00431993Medicare PIN