Provider Demographics
NPI:1568599124
Name:WELLS, HENRY GROVER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:GROVER
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:135 E MAXWELL ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2640
Mailing Address - Country:US
Mailing Address - Phone:859-255-6649
Mailing Address - Fax:859-255-7793
Practice Address - Street 1:135 E MAXWELL ST
Practice Address - Street 2:SUITE 402
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2640
Practice Address - Country:US
Practice Address - Phone:859-255-6649
Practice Address - Fax:859-255-7793
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
KY20227208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA13092Medicare UPIN