Healthcare Provider Details

I. General information

NPI: 1487612966
Provider Name (Legal Business Name): MARY DUNLAP WELLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTH INGLESIDE STE 6
FAIRHOPE AL
36532
US

IV. Provider business mailing address

150 SOUTH INGLESIDE SUITE 6
FAIRHOPE AL
36532
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-1222
  • Fax: 251-928-2398
Mailing address:
  • Phone: 251-928-1222
  • Fax: 251-928-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00026769
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: