MEDICARE: TINA TRAHAN WELLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D22798	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080137693	OTHER	LA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA TRAHAN WELLS MD

Provider Business Mailing Address
First Line	:	PO BOX 4869
Second Line	:	DEPARTMENT NUMBER 237
City	:	HOUSTON
State	:	TX
Zip	:	77210-4869
Country	:	US
Telephone Number	:	877-744-1141
Fax Number	:	847-537-4866

Provider Business Practice Location Address
First Line	:	17520 OLD JEFFERSON HWY
Second Line	:	STE. B
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3929
Country	:	US
Telephone Number	:	225-673-8983
Fax Number	:	225-677-8983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/08/2012

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Directions to “ TINA TRAHAN WELLS MD” Practice Location

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