Healthcare Provider Details

I. General information

NPI: 1154771178
Provider Name (Legal Business Name): BLAKE JOHN WELSCHMEYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

IV. Provider business mailing address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-0642
  • Fax: 573-449-1787
Mailing address:
  • Phone: 573-499-0642
  • Fax: 573-449-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2019024289
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019024289
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019024289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: