{
"Npi": {
"NPI": "1497714273",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WELLER",
"FirstName": "KATHRIN",
"MiddleName": "ANNETTE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WELLER",
"OtherFirstName": "K.",
"OtherMiddleName": "ANNETTE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "242 COUNTRY CLUB RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EUGENE",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-683-4242",
"MailingAddressFaxNumber": "541-343-5078",
"FirstLinePracticeLocationAddress": "242 COUNTRY CLUB RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EUGENE",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97401-2477",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-683-4242",
"PracticeLocationAddressFaxNumber": "541-343-5078",
"EnumerationDate": "03/21/2006",
"LastUpdateDate": "03/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "MD18201",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": "140170",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}