Provider Demographics
NPI:1659891455
Name:WELLER NEUROLOGY LLC
Entity Type:Organization
Organization Name:WELLER NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-669-0453
Mailing Address - Street 1:24900 SE STARK ST STE 211
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3382
Mailing Address - Country:US
Mailing Address - Phone:503-669-0435
Mailing Address - Fax:503-618-1859
Practice Address - Street 1:24900 SE STARK ST STE 211
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3382
Practice Address - Country:US
Practice Address - Phone:503-669-0435
Practice Address - Fax:503-618-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD173102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty