Healthcare Provider Details

I. General information

NPI: 1730168238
Provider Name (Legal Business Name): ARTHUR FRED WELLS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOVEY RD
PENSACOLA FL
32508-1044
US

IV. Provider business mailing address

1285 WHIPPOORWILL DR
CANTONMENT FL
32533-3803
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-2157
  • Fax:
Mailing address:
  • Phone: 850-474-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberME0063668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: