Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 04-25283 | KS |
Y | 207RG0100X | Gastroenterologist | DR.0062463 | CO |
NPI | 1043249931 |
---|---|
Provider Name | Dr. Thomas C Welton |
First Address | Colorado Springs, CO 80907-6265 |
Second Address | Colorado Springs, CO 80907-6265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067052 | MEDICARE PTAN (01) | KS |
100159190B | (05) | KS |
E90902 | (02) |