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General NPI Number Information
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NPI Number | 1801906136
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Entity Type | Individual
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Provider Name | STEPHEN EDWARD WELTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 100 THORNDALE DRIVE MEDICAL CLINIC
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City | SAN RAFAEL
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-492-2410
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Fax | 415-499-8395
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Provider Business Mailing Address
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Address Line | 16 SUTRO CT
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City | NOVATO
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State | CA
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Zip | 94947-2809
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Country | US
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Telephone | 415-309-1096
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Fax | 415-728-9879
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G37927
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License Number State | CA
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