Healthcare Provider Details

I. General information

NPI: 1720973712
Provider Name (Legal Business Name): ELLIOT WECHTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 SW RAMSEY AVE
GRANTS PASS OR
97527-5681
US

IV. Provider business mailing address

524 BROOKSIDE ACRES RD
MOUNTAIN REST SC
29664-9600
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: