Provider Demographics
NPI:1215962022
Name:WELKER, JAMES GLEN (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GLEN
Last Name:WELKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 PIPER STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:907-561-3967
Practice Address - Street 1:3831 PIPER STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:907-561-3967
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK493207Q00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA260Medicaid
AKK162754Medicare PIN
AKP56038Medicare UPIN
AK8EZ18FMedicare ID - Type Unspecified