Healthcare Provider Details

I. General information

NPI: 1437157484
Provider Name (Legal Business Name): BARRY PETERSON WELCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 YELLOWSTONE AVE SUITE 110
CODY WY
82414-9318
US

IV. Provider business mailing address

424 YELLOWSTONE AVE SUITE 110
CODY WY
82414-9318
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-5538
  • Fax:
Mailing address:
  • Phone: 307-587-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5652A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: