Healthcare Provider Details

I. General information

NPI: 1679527337
Provider Name (Legal Business Name): BENJAMINE MARK WELCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: B MARK WELCH DO

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N LYNN RIGGS BLVD
CLAREMORE OK
74017-3056
US

IV. Provider business mailing address

PO BOX 368
CLAREMORE OK
74018-0368
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-5088
  • Fax: 918-341-5023
Mailing address:
  • Phone: 918-342-0137
  • Fax: 918-342-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number3797
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: