Provider Demographics
NPI:1235154873
Name:WELLS, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:E
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9075 SW 87TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2308
Mailing Address - Country:US
Mailing Address - Phone:305-596-3400
Mailing Address - Fax:305-271-1706
Practice Address - Street 1:9075 SW 87TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2308
Practice Address - Country:US
Practice Address - Phone:305-596-3400
Practice Address - Fax:305-271-1706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0013126207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041432800Medicaid
D52225Medicare UPIN
FL041432800Medicaid