Provider Demographics
NPI:1669543328
Name:WELLS, GARY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEVEN
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:988 OAK RIDGE TURNPIKE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6936
Mailing Address - Country:US
Mailing Address - Phone:865-482-6790
Mailing Address - Fax:865-482-6706
Practice Address - Street 1:988 OAK RIDGE TURNPIKE
Practice Address - Street 2:SUITE 320
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6936
Practice Address - Country:US
Practice Address - Phone:865-482-6790
Practice Address - Fax:865-482-6706
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN18737207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031986Medicaid
TN3031986Medicaid
A99595Medicare UPIN