Healthcare Provider Details

I. General information

NPI: 1215962022
Provider Name (Legal Business Name): JAMES GLEN WELKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 PIPER STREET SUITE 220
ANCHORAGE AK
99508-4672
US

IV. Provider business mailing address

3831 PIPER STREET SUITE 220
ANCHORAGE AK
99508-4672
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3145
  • Fax: 907-561-3967
Mailing address:
  • Phone: 907-563-3145
  • Fax: 907-561-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number493
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: