Healthcare Provider Details

I. General information

NPI: 1043214422
Provider Name (Legal Business Name): JOHN J WELLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 1250
PHOENIX AZ
85032-2122
US

IV. Provider business mailing address

3020 E CAMELBACK RD SUITE 301
PHOENIX AZ
85014-5095
US

V. Phone/Fax

Practice location:
  • Phone: 602-493-3030
  • Fax: 602-493-0064
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14097
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: