Provider Demographics
NPI:1215914353
Name:WELTON, LAURIE A (DO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:WELTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 US HIGHWAY 1 STE 208
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3464
Mailing Address - Country:US
Mailing Address - Phone:772-299-7009
Mailing Address - Fax:772-562-7138
Practice Address - Street 1:1627 US HIGHWAY 1 STE 208
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3464
Practice Address - Country:US
Practice Address - Phone:772-299-7009
Practice Address - Fax:772-562-7138
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO2221782207RI0200X
FLOS8950207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00250143OtherRAILROAD
79717OtherBLUE CROSS
FLP00250143OtherRAILROAD
FLK8272Medicare PIN