Organization
PENINSULA CHILDRENS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY CHARLES WELLER MD (PEDIATRICIAN)
(360) 457-8578
Entity
Organization
Contact information
Practice address
902 E CAROLINE, PORT ANGELES, WA 98362
(360) 457-8578
(360) 457-4841
Mailing address
902 E CAROLINE, PORT ANGELES, WA 98362
(360) 457-8578
(360) 457-4841
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
601481297
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7058894
DSHS
WA
Enumeration date
04/27/2006
Last updated
11/05/2015
Update your record
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