Provider Demographics
NPI:1811011323
Name:WELLS, EUGENE C (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:C
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:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1164
Mailing Address - Country:US
Mailing Address - Phone:423-768-2525
Mailing Address - Fax:423-768-2525
Practice Address - Street 1:1720 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3522
Practice Address - Country:US
Practice Address - Phone:704-871-0081
Practice Address - Fax:704-871-0086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32065207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86473OtherBCBSNC
NC8986473Medicaid
NC86473OtherBCBSNC
NC8986473Medicaid