Provider Demographics
NPI:1477511160
Name:WELLS, ALKA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALKA
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
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 9210
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-9210
Mailing Address - Country:US
Mailing Address - Phone:850-476-8602
Mailing Address - Fax:850-474-3518
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0798782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258862500Medicaid
FL49992OtherBCBS
AL68491OtherBCBS OF ALABAMA
FLP00058282OtherRR MEDICARE
AL009931045OtherALABAMA EDS MEDICAID
AL68491OtherBCBS OF ALABAMA
FLH01316Medicare UPIN