Provider Demographics
NPI:1164602835
Name:WELLS, STEPHEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1420 VICEROY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2208
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:1720 E WHITESTONE BLVD STE A
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7641
Practice Address - Country:US
Practice Address - Phone:512-451-5800
Practice Address - Fax:512-459-1399
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2017-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN5477207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103594Medicare PIN