Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 00026193 | AL |
NPI | 1093763310 |
---|---|
Provider Name | Dr. Mell Burress Welborn III |
First Address | Huntsville, AL 35801-5134 |
Second Address | Huntsville, AL 35801-5134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051523433 | (05) | AL |
G73080 | (02) |