Individual
MR. JERRY RYAN WELBORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8375 HIGHWAY 72 W, MADISON, AL 35758-9573
(205) 265-2012
Mailing address
PO BOX 2045, MERIDIAN, MS 39302-2045
(662) 380-3513
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1-134799
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
R862001
MS
Other
Enumeration date
07/10/2006
Last updated
09/15/2024
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