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General NPI Number Information
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NPI Number | 1184894396
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Entity Type | Organization
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Legal Business Name | RAYMOND D. WELLS PSC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 62 ROCKCASTLE RD
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City | INEZ
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State | KY
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Zip | 41224-1088
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Country | US
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Telephone | 606-298-3412
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Fax | 606-298-7002
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Provider Business Mailing Address
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Address Line | PO BOX 1088
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City | INEZ
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State | KY
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Zip | 41224
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Country | US
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Telephone | 606-298-3412
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Fax | 606-298-7002
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND DOUGLAS WELLS
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Credential | M.D.
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Telephone | 606-298-3412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 14210
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License Number State | KY
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