Provider Demographics
NPI:1891715678
Name:WELKER, KENNETH JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAY
Last Name:WELKER
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 1:1200 EXECUTIVE PKWY
Mailing Address - Street 2:STE 360
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2114
Mailing Address - Country:US
Mailing Address - Phone:541-762-1155
Mailing Address - Fax:541-762-1154
Practice Address - Street 1:1200 EXECUTIVE PKWY
Practice Address - Street 2:STE 360
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2114
Practice Address - Country:US
Practice Address - Phone:541-762-1155
Practice Address - Fax:541-762-1154
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008834Medicaid
OR131424Medicare ID - Type Unspecified
OR008834Medicaid