MEDICARE: HENRY NELSON WELLMAN M.D.

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	207R00000X	Internal Medicine Physician	01024231A	IN

General Provider Information

NPI Number	:	1669860870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY NELSON WELLMAN M.D.

Provider Business Mailing Address
First Line	:	5747 NE 61ST AVENUE RD
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-1243
Country	:	US
Telephone Number	:	352-236-0895
Fax Number	:

Provider Business Practice Location Address
First Line	:	5747 NE 61ST AVENUE RD
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-1243
Country	:	US
Telephone Number	:	352-236-0895
Fax Number	:

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

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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