Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 25MB10551600 | NJ |
Y | 207Q00000X | Family Doctor | 25MB10551600 | NJ |
NPI | 1063808269 |
---|---|
Provider Name | Dr. Craig Allen Wells |
First Address | Egg Harbor Township, NJ 08234-6012 |
Second Address | Egg Harbor Township, NJ 08234-6012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 24/11/2020 |