Provider Demographics
NPI:1811168701
Name:WELLS, GREGG BENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:BENNETT
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:440 REYNOLDS MEDICAL BUILDING
Mailing Address - Street 2:1114TAMU/MOLECULAR AND CELLULAR MEDICINE
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1114
Mailing Address - Country:US
Mailing Address - Phone:979-458-8888
Mailing Address - Fax:979-847-9481
Practice Address - Street 1:440 REYNOLDS MEDICAL BUILDING
Practice Address - Street 2:1114TAMU/MOLECULAR AND CELLULAR MEDICINE
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-1114
Practice Address - Country:US
Practice Address - Phone:979-458-8888
Practice Address - Fax:979-847-9481
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL0687207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60867Medicare UPIN