MEDICARE: DANIEL JUSTIN WELSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	ME146760	FL

General Provider Information

NPI Number	:	1396270500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JUSTIN WELSH MD

Provider Business Mailing Address
First Line	:	17 DAVIS BLVD
Second Line	:	SUITE 308
City	:	TAMPA
State	:	FL
Zip	:	33606-3475
Country	:	US
Telephone Number	:	813-250-2506
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 CROSSOVER RD
Second Line	:
City	:	CRESCENT CITY
State	:	FL
Zip	:	32112-4669
Country	:	US
Telephone Number	:	937-674-4189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	11/06/2020

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