Provider Demographics
NPI:1275524431
Name:WELLS, JOHN W JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:WELLS
Suffix:JR
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:PO BOX 19675
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9675
Mailing Address - Country:US
Mailing Address - Phone:904-309-8680
Mailing Address - Fax:904-345-5841
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:BLDG 100, SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4252
Practice Address - Country:US
Practice Address - Phone:904-391-1100
Practice Address - Fax:904-391-1109
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 394152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53630OtherBCBS
FLO42404800Medicaid
FL208063OtherAVMED
FLP00199547OtherMEDICARE RAILROAD
FLBL088RMedicare PIN
FL53630TMedicare PIN
FL53630MMedicare PIN
FLBL088PMedicare PIN
FLBL088TMedicare PIN
FLBL088ZMedicare PIN
FL53630OMedicare PIN
FLBL088VMedicare PIN
FL53630OtherBCBS
FLP00199547OtherMEDICARE RAILROAD
FLD64500Medicare UPIN
GA92BBFQZMedicare PIN