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General NPI Number Information
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NPI Number | 1952410706
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Entity Type | Individual
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Provider Name | SAMUEL BRADLEY WELCH M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 4300 W 7TH ST CAVHS SURGICAL SERVICE 112/LR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5446
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Country | US
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Telephone | 501-257-4615
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Fax | 501-257-6810
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Provider Business Mailing Address
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Address Line | 3 WILLIAMSBURG CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2234
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Country | US
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Telephone |
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Fax |
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | C6223
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License Number State | AR
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