Provider Demographics
NPI:1467400028
Name:WELLS, ERVIN (MD)
Entity Type:Individual
Prefix:
First Name:ERVIN
Middle Name:
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 1:8130 SEATON PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7204
Mailing Address - Country:US
Mailing Address - Phone:334-356-7802
Mailing Address - Fax:334-356-8456
Practice Address - Street 1:8130 SEATON PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7204
Practice Address - Country:US
Practice Address - Phone:334-356-7802
Practice Address - Fax:334-356-8456
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine