Provider Demographics
NPI:1659393759
Name:WENNER, KARL C (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:C
Last Name:WENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1106
Mailing Address - Country:US
Mailing Address - Phone:541-274-6564
Mailing Address - Fax:541-274-6247
Practice Address - Street 1:2821 DAGGETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1106
Practice Address - Country:US
Practice Address - Phone:541-274-6733
Practice Address - Fax:541-274-2006
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15968207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORXPY113830OtherMEDI-CAL
OR098830Medicaid
OR098830Medicaid
ORXPY113830OtherMEDI-CAL
OR055587000OtherBLUE CROSS
OR93115601597601OtherTRICARE
ORR138984Medicare PIN
OR93115601597601OtherTRICARE
OR0938890001Medicare NSC
ORR0000BKBWMedicare PIN