Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 133112 | NY |
Y | 2080P0208X | Pediatric Infectious Diseases | 133112 | NY |
N | 2080P0210X | Pediatric Nephrologist | 133112 | NY |
NPI | 1184723132 |
---|---|
Provider Name | Dr. Robert C Welliver |
First Address | Oklahoma City, OK 73117-1039 |
Second Address | Oklahoma City, OK 73104-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 10/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010187604 | UNIVERA (01) | NY |
000507730001 | BC/BS (01) | NY |
000507730004 | BC OF KANSAS (01) | |
000507730004 | BC/BS (01) | NY |
000507730005 | BC OF KANSAS (01) | |
000507730005 | BC/BS (01) | NY |
00735837 | (05) | NY |
040426000753 | FIDELIS (01) | NY |
080222000049 | FIDELIS (01) | NY |
3905807 | IHA (01) | NY |
F28285 | (02) |