Healthcare Provider Details

I. General information

NPI: 1629092903
Provider Name (Legal Business Name): JOE WELLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

IV. Provider business mailing address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-8753
  • Fax: 512-483-6828
Mailing address:
  • Phone: 512-459-8753
  • Fax: 512-483-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ9566
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number44430
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberJ9566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: