Healthcare Provider Details

I. General information

NPI: 1720041957
Provider Name (Legal Business Name): DAVID I WELLS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE STE 103
MODESTO CA
95350-4438
US

IV. Provider business mailing address

1541 FLORIDA AVE STE 103
MODESTO CA
95350-4438
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-3388
  • Fax: 209-575-5836
Mailing address:
  • Phone: 209-577-3388
  • Fax: 209-575-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: