Provider Demographics
NPI:1528057544
Name:WELCH, BRANDY N (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:N
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:
Practice Address - Street 1:2875 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-4594
Practice Address - Country:US
Practice Address - Phone:214-872-1877
Practice Address - Fax:214-872-3114
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID71407OtherBLUE CROSS
ID806965900OtherHEALTHY CONNECTING
ID806964800Medicaid
IDB1212OtherBLUE CROSS
ID000010147851OtherBLUE SHIELD
ID000010147850OtherBLUE SHIELD
ID806964800Medicaid
ID000010147850OtherBLUE SHIELD