Provider Demographics
NPI:1427202621
Name:WELLS, BRADLEY E (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
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:PO BOX 2648
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2648
Mailing Address - Country:US
Mailing Address - Phone:606-432-1357
Mailing Address - Fax:606-432-2457
Practice Address - Street 1:911 BYPASS RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-432-1357
Practice Address - Fax:606-432-2457
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY460052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427202621OtherVIRGINIA MEDICAID
KY7100241640Medicaid
KY000000821046OtherANTHEM
KYK091710OtherMEDICARE
KYP01223063OtherRAILROAD MEDICARE