Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 10515 | SC |
NPI | 1023009032 |
---|---|
Provider Name | Julius Warren Welborn III |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105157 | (05) | SC |
D17684 | (02) | SC |
P00725462 | RR MEDICARE (01) | SC |