Provider Demographics
NPI:1790733103
Name:WELLS, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6326 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4560
Mailing Address - Country:US
Mailing Address - Phone:214-924-0229
Mailing Address - Fax:214-361-3431
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 851
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-826-6044
Practice Address - Fax:214-826-0848
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9825207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137735001Medicaid
TX137735003Medicaid
TXC23327Medicare UPIN
TX137735003Medicaid
TX137735001Medicaid
TXTXB128684Medicare PIN