Healthcare Provider Details

I. General information

NPI: 1740278183
Provider Name (Legal Business Name): ROBERT W WELKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W TELEGRAPH ST
WASHINGTON UT
84780-1675
US

IV. Provider business mailing address

195 W TELEGRAPH ST
WASHINGTON UT
84780-1675
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-4444
  • Fax: 435-628-4447
Mailing address:
  • Phone: 435-628-4444
  • Fax: 435-628-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1768961205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: