{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "STACEY WELLS MD PLLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "935 ELDRIDGE RD PMB 307",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUGAR LAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77478-2809",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "832-617-0318",
"MailingAddressFaxNumber": "833-357-2154",
"FirstLinePracticeLocationAddress": "1315 ST JOSEPH PKWY STE 1400",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOUSTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77002-8237",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "832-617-0318",
"PracticeLocationAddressFaxNumber": "833-357-2154",
"EnumerationDate": "09/03/2015",
"LastUpdateDate": "01/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WELLS",
"AuthorizedOfficialFirstName": "STACEY",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "HOSPITALIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "678-427-4494",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "Q2410",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}