Provider Demographics
NPI:1245210400
Name:WELLS, BRITTON C (MD)
Entity Type:Individual
Prefix:
First Name:BRITTON
Middle Name:C
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-706-8526
Mailing Address - Fax:
Practice Address - Street 1:703 S AMERICANA BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5099
Practice Address - Country:US
Practice Address - Phone:208-323-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087310207X00000X
IDM12897207X00000X
CAA78982207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A789820OtherMEDICAL
CA136043001Medicaid
CA00A789820OtherMEDICAL
CA136043001Medicaid