MEDICARE: DR. GREGG BENNETT WELLS 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	207ZN0500X	Neuropathology Physician	L0687	TX

General Provider Information

NPI Number	:	1811168701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG BENNETT WELLS M.D.

Provider Business Mailing Address
First Line	:	440 REYNOLDS MEDICAL BUILDING
Second Line	:	1114TAMU/MOLECULAR AND CELLULAR MEDICINE
City	:	COLLEGE STATION
State	:	TX
Zip	:	77843-1114
Country	:	US
Telephone Number	:	979-458-8888
Fax Number	:	979-847-9481

Provider Business Practice Location Address
First Line	:	440 REYNOLDS MEDICAL BUILDING
Second Line	:	1114TAMU/MOLECULAR AND CELLULAR MEDICINE
City	:	COLLEGE STATION
State	:	TX
Zip	:	77843-1114
Country	:	US
Telephone Number	:	979-458-8888
Fax Number	:	979-847-9481

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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