Provider Demographics
NPI:1912002684
Name:WELLS, JOE BRETT (CRT)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:BRETT
Last Name:WELLS
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4838
Mailing Address - Country:US
Mailing Address - Phone:580-338-4012
Mailing Address - Fax:580-338-4017
Practice Address - Street 1:301 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4838
Practice Address - Country:US
Practice Address - Phone:580-338-4012
Practice Address - Fax:580-338-4017
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16-02033332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies