MEDICARE: DR. SARA A 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	953098541205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080131162	OTHER	UT	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1528164621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA A WELLS MD

Provider Business Mailing Address
First Line	:	2131 E 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1128
Country	:	US
Telephone Number	:	801-474-0355
Fax Number	:	801-485-8007

Provider Business Practice Location Address
First Line	:	2131 E 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1128
Country	:	US
Telephone Number	:	801-474-0355
Fax Number	:	801-485-8007

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	03/26/2014

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Directions to “ DR. SARA A WELLS MD” Practice Location

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