Provider Demographics
NPI:1467459420
Name:WELLS, CRAIG G (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:G
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 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUTIE D050
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:206-215-3850
Practice Address - Fax:206-215-3870
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2012-02-29
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
WAMD00018725207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7081888Medicaid
WA0288403OtherL & I FOR PROLIANCE SURGEONS, INC.
WA0288403OtherL & I FOR PROLIANCE SURGEONS, INC.
WAA05904Medicare UPIN