Provider Demographics
NPI:1639104813
Name:WELLS, TERRY LYNN (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GASLIGHT MEDICAL PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3149
Mailing Address - Country:US
Mailing Address - Phone:936-634-3329
Mailing Address - Fax:936-634-7237
Practice Address - Street 1:1015 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3397
Practice Address - Country:US
Practice Address - Phone:936-634-3329
Practice Address - Fax:936-634-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000N89D4Medicaid
TX00N89DMedicare ID - Type Unspecified
TXP000N89D4Medicaid