Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | H6979 | TX |
NPI | 1023179439 |
---|---|
Provider Name | Dr. Timothy Michael Welter |
First Address | China Spring, TX 76633-2802 |
Second Address | Waco, TX 76708-3239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |