Provider Demographics
NPI:1417052671
Name:WELLS, JAMES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2880 ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-595-6543
Mailing Address - Fax:562-981-1955
Practice Address - Street 1:2880 ATLANTIC AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-595-6543
Practice Address - Fax:562-981-1955
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC33481208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089080Medicaid
W15053Medicare ID - Type Unspecified
CAGR0089080Medicaid