Healthcare Provider Details

I. General information

NPI: 1861933871
Provider Name (Legal Business Name): JUSTIN WELSH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 E SOUTHERN AVE
MESA AZ
85206-2791
US

IV. Provider business mailing address

5110 E SOUTHERN AVE
MESA AZ
85206-2791
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-4499
  • Fax: 415-252-7176
Mailing address:
  • Phone:
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP61607809
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1021233
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024-03131
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV4523
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0074143
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number103296
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number008375
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: