MEDICARE: RICHARD GORDON WELEBER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD08302	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180040496	OTHER		RAILROAD MEDICARE RRM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134171465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD GORDON WELEBER MD

Provider Business Mailing Address
First Line	:	3375 SW TERWILLIGER BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239
Country	:	US
Telephone Number	:	503-494-6107
Fax Number	:	503-494-0470

Provider Business Practice Location Address
First Line	:	3375 SW TERWILLIGER BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239
Country	:	US
Telephone Number	:	503-494-8386
Fax Number	:	503-494-2218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/18/2008

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