MEDICARE: DR. ALVIN F WELLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	46013	WI
2	207RR0500X	Rheumatology Physician	ME169775	FL

General Provider Information

NPI Number	:	1134234859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN F WELLS MD

Provider Business Mailing Address
First Line	:	917 MAR WALT DR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6651
Country	:	US
Telephone Number	:	850-862-3979
Fax Number	:	850-862-0605

Provider Business Practice Location Address
First Line	:	137 CRYSTAL BEACH DR STE 121
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-3573
Country	:	US
Telephone Number	:	850-807-4388
Fax Number	:	850-862-3979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/28/2024

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