Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 00015913 | AL |
NPI | 1013908078 |
---|---|
Provider Name | George R. Wells III |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35205-3423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 25/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000079846 | (05) | AL |
051595537 | BLUE CROSS (01) | AL |
051595538 | BLUE CROSS (01) | AL |
106761 | (05) | AL |
107155 | (05) | AL |
F80342 | (02) | |
P00821356 | RAILROAD MEDICARE (01) | AL |