Provider Demographics
NPI:1578702536
Name:WELCH, JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:FRANCIS
Other - Middle Name:JOSEPH
Other - Last Name:WELCH
Other - Suffix:IV
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9135 SW BARNES RD STE 875
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6683
Mailing Address - Country:US
Mailing Address - Phone:503-297-3440
Mailing Address - Fax:503-297-4584
Practice Address - Street 1:9135 SW BARNES RD STE 875
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6683
Practice Address - Country:US
Practice Address - Phone:503-297-3440
Practice Address - Fax:503-297-4584
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19919363A00000X
ORPA130039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR148479OtherPTAN