Basic Information
| Provider Information | |||||||||
| NPI: | 1760835649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARY B WELLS MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704242200 | ||||||||
| FaxNumber: | 8704246616 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704242200 | ||||||||
| FaxNumber: | 8704246616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | WELLS | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8704242200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N7796 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.