Provider Demographics
NPI:1942229604
Name:WELLS, WINFIELD J (MD)
Entity Type:Individual
Prefix:
First Name:WINFIELD
Middle Name:J
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 1:1520 SAN PABLO ST
Mailing Address - Street 2:SUITUE 4300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5330
Mailing Address - Country:US
Mailing Address - Phone:323-442-6245
Mailing Address - Fax:323-442-5956
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITUE 4300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5330
Practice Address - Country:US
Practice Address - Phone:323-442-6245
Practice Address - Fax:323-442-5956
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31277208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G312770OtherBLUE SHIELD PIN
CA00G312770Medicaid
CA00G312770F94OtherCAL OPTIMA NUMBER
CA060055833OtherMEDICARE RAILROAD PIN
A44709Medicare UPIN
CA060055833OtherMEDICARE RAILROAD PIN
CAWG31277DMedicare PIN