MEDICARE: WILLIAM R WELBORN JR. M. D.

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	207N00000X	Dermatology Physician	6193	AL

General Provider Information

NPI Number	:	1346329505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R WELBORN JR. M. D.

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:	211 NORTH ATLANTA AVENUE
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-0549
Country	:	US
Telephone Number	:	256-381-1465
Fax Number	:	256-386-0352

Provider Business Practice Location Address
First Line	:	211 N ATLANTA AVE
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-3003
Country	:	US
Telephone Number	:	256-381-1465
Fax Number	:	256-386-0352

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/09/2007

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