Healthcare Provider Details

I. General information

NPI: 1346291796
Provider Name (Legal Business Name): KERRY D WELCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N 1220 E #15
AMERICAN FORK UT
84003
US

IV. Provider business mailing address

120 N 1220 E
AMERICAN FORK UT
84003-2946
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-5241
  • Fax: 801-756-9102
Mailing address:
  • Phone: 801-756-5241
  • Fax: 801-756-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number870467383
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: