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General NPI Number Information
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NPI Number | 1053789370
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Entity Type | Organization
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Legal Business Name | STACEY WELLS MD PLLC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 1315 ST JOSEPH PKWY STE 1400
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City | HOUSTON
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State | TX
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Zip | 77002-8237
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Country | US
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Telephone | 832-617-0318
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Fax | 833-357-2154
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Provider Business Mailing Address
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Address Line | 935 ELDRIDGE RD PMB 307
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City | SUGAR LAND
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State | TX
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Zip | 77478-2809
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Country | US
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Telephone | 832-617-0318
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Fax | 833-357-2154
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Authorized Official
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Title or Position | HOSPITALIST
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Name | DR. STACEY M WELLS
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Credential | MD
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Telephone | 678-427-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | Q2410
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License Number State | TX
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