Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | TX1355 | TX |
NPI | 1083612238 |
---|---|
Provider Name | Jed M Wells |
First Address | Corpus Christi, TX 78466-0998 |
Second Address | Laredo, TX 78041-2286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 11/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092738602 | (05) | TX |
U32769 | (02) | TX |