Provider Demographics
NPI:1902872716
Name:WELCH, LAURA J (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4848 NE STALLINGS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1266
Mailing Address - Country:US
Mailing Address - Phone:362-215-7739
Mailing Address - Fax:936-585-6126
Practice Address - Street 1:4848 NE STALLINGS DR STE 202
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1266
Practice Address - Country:US
Practice Address - Phone:936-221-5773
Practice Address - Fax:936-305-5331
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL4204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB149242Medicare PIN