Provider Demographics
NPI:1952410706
Name:WELCH, SAMUEL BRADLEY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BRADLEY
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILLIAMSBURG CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:CAVHS SURGICAL SERVICE 112/LR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-4615
Practice Address - Fax:501-257-6810
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6223207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR14623000000OtherQUALCHOICE
AR55591OtherBCBS
ARC6223OtherTRICARE
ARC6223OtherTRICARE
AR55591OtherBCBS