Provider Demographics
NPI:1831282508
Name:WELLS, DAVID WOODBURNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WOODBURNE
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 1:8284 N SUNBURST TRL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6920
Mailing Address - Country:US
Mailing Address - Phone:303-841-3888
Mailing Address - Fax:303-866-7383
Practice Address - Street 1:4143 S JULIAN WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3101
Practice Address - Country:US
Practice Address - Phone:303-866-7339
Practice Address - Fax:303-866-7383
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO218762080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01218767Medicaid