Healthcare Provider Details

I. General information

NPI: 1376662049
Provider Name (Legal Business Name): DARRYL S WELLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 17TH AVE SUITE 680
SEATTLE WA
98122-5788
US

IV. Provider business mailing address

5726 16TH AVE NE
SEATTLE WA
98105-2519
US

V. Phone/Fax

Practice location:
  • Phone: 206-861-8550
  • Fax:
Mailing address:
  • Phone: 206-718-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD00042621
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: