Provider Demographics
NPI:1710920921
Name:WELLS, JENNIFER T (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
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 1:1111 W 34TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1900
Mailing Address - Country:US
Mailing Address - Phone:512-454-8378
Mailing Address - Fax:512-454-8375
Practice Address - Street 1:1130 COTTONWOOD CREEK TRL STE C1
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-454-8375
Practice Address - Fax:888-965-8836
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4198207RT0003X
TXN4128207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204265701Medicaid
TX204265703Medicaid
TX8CB782OtherBCBSTX
TXP00878779Medicare PIN
TXTXB110532Medicare PIN
TX8L15679Medicare PIN