Healthcare Provider Details

I. General information

NPI: 1467417386
Provider Name (Legal Business Name): JAMES D. WELSH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J DOUGLAS WELSH PA-C

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 BUSINESS CENTER CT
DAYTON OH
45410-3300
US

IV. Provider business mailing address

P.O. BOX 1965 SEPI
SPRINGFIELD OH
45501
US

V. Phone/Fax

Practice location:
  • Phone: 937-254-0160
  • Fax: 937-254-1478
Mailing address:
  • Phone: 937-399-3571
  • Fax: 937-717-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50-002096
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: