Individual
DR. MATTHEW WELLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
155 EAST WARNER ROAD, SUITE B, GILBERT, AZ 85295
(480) 649-6600
(480) 649-6700
Mailing address
155 E WARNER RD, GILBERT, AZ 85296-3082
(480) 649-6600
(480) 649-6700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00045733
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124098
—
WA
01
—
1225257363
GRP NPI, W OLY FAM MED
WA
01
—
8868890
GROUP PTAN, W OLY FAM MED
WA
Enumeration date
07/11/2006
Last updated
08/20/2013
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