Provider Demographics
NPI:1154765733
Name:WELLS, KEVIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2806 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2601
Mailing Address - Country:US
Mailing Address - Phone:979-776-8330
Mailing Address - Fax:979-774-9157
Practice Address - Street 1:2806 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2601
Practice Address - Country:US
Practice Address - Phone:979-776-8330
Practice Address - Fax:979-774-9157
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9889207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist