Provider Demographics
NPI:1477568749
Name:WELLS, FORREST SIMPSON (MD)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:SIMPSON
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 1:4509 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-6026
Mailing Address - Country:US
Mailing Address - Phone:228-872-3993
Mailing Address - Fax:228-872-3992
Practice Address - Street 1:4509 GIBSON RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-6026
Practice Address - Country:US
Practice Address - Phone:228-872-3993
Practice Address - Fax:228-872-3992
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS180502086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP0007341ZOtherMEDICARE RAILROAD
MS03479057Medicaid
MSP0007341ZOtherMEDICARE RAILROAD
MS240000089Medicare ID - Type Unspecified