Provider Demographics
NPI:1891785887
Name:WELLS, GUY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:ALAN
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 1:3819 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1829
Mailing Address - Country:US
Mailing Address - Phone:806-797-7000
Mailing Address - Fax:806-797-7055
Practice Address - Street 1:3819 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1829
Practice Address - Country:US
Practice Address - Phone:806-797-7000
Practice Address - Fax:806-797-7055
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9005207RC0000X, 193200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No193200000XGroupMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100152200AMedicaid
TX126636101Medicaid
TX83625ZOtherHMO BLUE
TX126636104OtherFIRSTCARE COMMERICAL
TX127448203Medicaid
TX82980XOtherBC/BS
NMA602OtherTRIWEST
NM37477OtherPRESBYTERIAN COMMERCIAL
NM37477Medicaid
NMZ2226Medicaid
TX127448207Medicaid
TXC23333Medicare UPIN
TX83670NMedicare PIN
TX82980XOtherBC/BS