Provider Demographics
NPI:1871781252
Name:MATTHEW J WELTER MD PC
Entity type:Organization
Organization Name:MATTHEW J WELTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:4357-139-1303
Mailing Address - Street 1:2380 N 400 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1749
Mailing Address - Country:US
Mailing Address - Phone:435-713-1303
Mailing Address - Fax:435-787-9601
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:SUITE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1749
Practice Address - Country:US
Practice Address - Phone:435-713-1303
Practice Address - Fax:435-787-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59345411205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty