=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447251392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA M WELSH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 10/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 WENDELL AVE SUITE 103
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59457-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-535-1480
-----------------------------------------------------
Fax | 406-535-1481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 WENDELL AVE SUITE 103
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59457-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-535-1480
-----------------------------------------------------
Fax | 406-535-1481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10601
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------