MEDICARE: DR. ROXIE C WELLS M.D.

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	200200299	NC

General Provider Information

NPI Number	:	1740331545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXIE C WELLS M.D.

Provider Business Mailing Address
First Line	:	112 MEDICAL VILLAGE DR
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1668
Country	:	US
Telephone Number	:	910-285-2111
Fax Number	:	910-285-4436

Provider Business Practice Location Address
First Line	:	112 MEDICAL VILLAGE DR
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1668
Country	:	US
Telephone Number	:	910-285-2111
Fax Number	:	910-285-4436

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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