Basic Information
| Provider Information | |||||||||
| NPI: | 1083626121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4585 SW 185TH AVE | ||||||||
| Address2: | |||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970781557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035919280 | ||||||||
| FaxNumber: | 5038482072 | ||||||||
| Practice Location | |||||||||
| Address1: | 4585 SW 185TH AVE | ||||||||
| Address2: | |||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035919280 | ||||||||
| FaxNumber: | 5038482072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD17971 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | F07035 | 05 | OR | MEDICAID |