Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10276 | MT |
NPI | 1003859083 |
---|---|
Provider Name | Dr. Richard Wells |
First Address | Roundup, MT 59072-0873 |
Second Address | Miles City, MT 59301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000083717 | MEDICARE PART B GROUPPTAN (01) | MT |
011000906 | MEDICARE PART B PTAN (01) | MT |
271824 | MEDICARE PART A PIN (01) | MT |
98966 | BLUE CROSS BLUE SHIELD MT (01) | MT |
H74753 | (02) |