MEDICARE: VINCENT WELTER 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	207V00000X	Obstetrics & Gynecology Physician	MD00038222	WA

General Provider Information

NPI Number	:	1366719106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT WELTER M.D.

Provider Business Mailing Address
First Line	:	1706 FRONT ST
Second Line	:
City	:	LYNDEN
State	:	WA
Zip	:	98264-1261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 E DYER RD
Second Line	:	145
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5611
Country	:	US
Telephone Number	:	877-569-5671
Fax Number	:

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	05/14/2013

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