Provider Demographics
NPI:1770812588
Name:WELKER, JONATHAN ELLIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ELLIS
Last Name:WELKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JON
Other - Middle Name:
Other - Last Name:WELKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-8800
Mailing Address - Fax:303-415-8801
Practice Address - Street 1:4801 RIVERBEND RD STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2613
Practice Address - Country:US
Practice Address - Phone:303-415-8800
Practice Address - Fax:303-415-8801
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO311790YLL6Medicare PIN
CO311790YLL6Medicare PIN