Basic Information
| Provider Information | |||||||||
| NPI: | 1629159264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELKER | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10622 | ||||||||
| Address2: | |||||||||
| City: | ZEPHYR COVE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894482622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 72 HIGH ST #23 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ZEPHYR COVE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894482622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092405855 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 13539 | NV | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | C54092 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 162915264 | 05 | NV | MEDICAID | 1629159264 | 05 | CA | MEDICAID | 8518748 | 05 | WA | MEDICAID |