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General NPI Number Information
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NPI Number | 1871781252
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Entity Type | Organization
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Legal Business Name | MATTHEW J WELTER MD PC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 2380 N 400 E SUITE A
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City | LOGAN
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State | UT
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Zip | 84341-1749
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Country | US
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Telephone | 435-713-1303
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Fax | 435-787-9601
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Provider Business Mailing Address
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Address Line | 2380 N 400 E SUITE A
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City | LOGAN
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State | UT
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Zip | 84341-1749
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Country | US
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Telephone | 435-713-1303
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Fax | 435-787-9601
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Authorized Official
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Title or Position | DOCER
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Name | MATTHEW JOHN WELTER
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Credential | MD
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Telephone | 43571391303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 59345411205
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License Number State | UT
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