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General NPI Number Information
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NPI Number | 1144391772
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Entity Type | Organization
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Legal Business Name | WELLS GASTROENTEROLOGY PLLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/27/2014
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Provider Practice Location Address
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Address Line | 6000 N BAILEY AVE
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City | AMHERST
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State | NY
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Zip | 14226-5102
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Country | US
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Telephone | 716-834-6152
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Fax | 716-834-5755
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Provider Business Mailing Address
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Address Line | 6000 N BAILEY AVE
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City | AMHERST
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State | NY
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Zip | 14226-5102
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Country | US
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Telephone | 716-834-6152
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Fax | 716-834-5755
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE V WELLS
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Credential | M.D.
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Telephone | 716-834-6152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 194653
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License Number State | NY
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