Healthcare Provider Details

I. General information

NPI: 1417146283
Provider Name (Legal Business Name): PATRICK JOSEPH WELCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEAULLIEU DRIVE, BUILDING 1
LAFAYETTE LA
70508-7230
US

IV. Provider business mailing address

200 BEAULLIEU DRIVE, BUILDING 1
LAFAYETTE LA
70508-7230
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-6808
  • Fax: 337-289-6807
Mailing address:
  • Phone: 337-289-6808
  • Fax: 337-289-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD12979R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: