Healthcare Provider Details

I. General information

NPI: 1760437313
Provider Name (Legal Business Name): WESTON J WELKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CHATEAU DRIVE SUITE 302
HUNTSVILLE ALABAMA
35801
UM

IV. Provider business mailing address

600 WHITESPORT CIR SW
HUNTSVILLE AL
35801-6495
US

V. Phone/Fax

Practice location:
  • Phone: 256-705-4402
  • Fax: 256-705-4630
Mailing address:
  • Phone: 256-882-2003
  • Fax: 256-882-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13209
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.13209
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00013209
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: