MEDICARE: PATRICIA A WELBORN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA01072	TX

General Provider Information

NPI Number	:	1295857902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A WELBORN PA

Provider Business Mailing Address
First Line	:	5701 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75236-1047
Country	:	US
Telephone Number	:	214-775-2927
Fax Number	:	214-330-2002

Provider Business Practice Location Address
First Line	:	5701 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75236-1047
Country	:	US
Telephone Number	:	214-775-2927
Fax Number	:	214-330-2002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/23/2011

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Directions to “ PATRICIA A WELBORN PA” Practice Location

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