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General NPI Number Information
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NPI Number | 1679013445
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Entity Type | Individual
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Provider Name | LUKE ROBERT WELLE MD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 1253 NW CANAL BLVD
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City | REDMOND
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State | OR
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Zip | 97756-1334
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Country | US
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Telephone | 541-548-8131
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Fax | 541-526-6608
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Provider Business Mailing Address
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Address Line | MSC 11-6025 1 UNIVERSITY OF NEW MEXICO
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-272-5062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | RS2018-0322
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD2020-0840
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License Number State | NM
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