Healthcare Provider Details

I. General information

NPI: 1427160951
Provider Name (Legal Business Name): LAURENCE E WELKER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

915 OLIVE ST
SHREVEPORT LA
71104-2103
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax:
Mailing address:
  • Phone: 318-227-0810
  • Fax: 318-227-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD129R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: