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General NPI Number Information
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NPI Number | 1902855646
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Entity Type | Individual
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Provider Name | MARY LUCILLE WELP M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 2230 BRYAN PL SUITE 200
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7147
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Country | US
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Telephone | 972-775-4132
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Fax | 972-775-4620
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Provider Business Mailing Address
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Address Line | 2230 BRYAN PL STE#200
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7147
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Country | US
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Telephone | 972-775-4132
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Fax | 972-775-4620
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G6640
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License Number State | TX
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