Provider Demographics
NPI:1992573638
Name:VOSMITH, WELTON JAMES
Entity type:Individual
Prefix:
First Name:WELTON
Middle Name:JAMES
Last Name:VOSMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W BROADWAY APT 17
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3824
Mailing Address - Country:US
Mailing Address - Phone:660-492-9810
Mailing Address - Fax:
Practice Address - Street 1:105 W BROADWAY APT 17
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3824
Practice Address - Country:US
Practice Address - Phone:660-492-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program