Basic Information
| Provider Information | |||||||||
| NPI: | 1619573490 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MATTHEW WELTER MD | ||||||||
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| OtherOrganizationName: | MATTHEW WELTER M.D.,P.C. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 E 13000 N | ||||||||
| Address2: | |||||||||
| City: | COVE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843202130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357578943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1219 N 400 E | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843412321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359322025 | ||||||||
| FaxNumber: | 4352154420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2020 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | WELTER | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4357578943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.