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NPI Code Detail

MEDICARE: DR. STACEY MAXINE WELLS MD

MEDICARE: DR. STACEY MAXINE 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
1208M00000XHospitalist PhysicianQ2410TX
2207R00000XInternal Medicine PhysicianQ2410TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578855466
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY MAXINE WELLS MD
Provider Business Mailing Address
First Line : 11511 SHADOW CREEK PKWY
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7298
Country : US
Telephone Number : 713-442-0000
Fax Number :
Provider Business Practice Location Address
First Line : 1315 ST JOSEPH PKWY STE 1400
Second Line :
City : HOUSTON
State : TX
Zip : 77002-8237
Country : US
Telephone Number : 832-617-0319
Fax Number : 281-727-3490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2011
Last Update Date : 09/20/2023

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Directions to “ DR. STACEY MAXINE WELLS MD” Practice Location

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