Provider Demographics
NPI:1093794968
Name:WELLS, TAMMY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JO
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1820 E 54TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2763
Mailing Address - Country:US
Mailing Address - Phone:563-355-9990
Mailing Address - Fax:563-355-9999
Practice Address - Street 1:1820 E 54TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2763
Practice Address - Country:US
Practice Address - Phone:563-355-9990
Practice Address - Fax:563-355-9999
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA30073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine