Provider Demographics
NPI:1114902087
Name:WELLS, JOEL ALAN (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ALAN
Last Name:WELLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-8713
Mailing Address - Country:US
Mailing Address - Phone:641-872-2896
Mailing Address - Fax:
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:SUITE #100
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2063
Practice Address - Fax:641-872-2070
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1299727Medicaid
IA1299727Medicaid
IAE03963Medicare UPIN