Provider Demographics
NPI:1427116631
Name:WELBORN, MELL B JR (MD)
Entity type:Individual
Prefix:
First Name:MELL
Middle Name:B
Last Name:WELBORN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-7700
Mailing Address - Fax:812-450-7705
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:STE 350
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5610
Practice Address - Country:US
Practice Address - Phone:812-450-7700
Practice Address - Fax:812-450-7705
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01023603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100239950Medicaid
KY64346430Medicaid
IN636570PMedicare PIN
KY64346430Medicaid