Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A61831 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | A61831 | CA |
NPI | 1235179144 |
---|---|
Provider Name | Dr. John Hearst Welborn JR. |
First Address | Pinole, CA 94564-2081 |
Second Address | Pinole, CA 94564-2081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A618310 | (05) | CA |
H42664 | (02) | CA |