Provider Demographics
NPI:1285618454
Name:WELLS, CHRISTOPHER D (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4707
Mailing Address - Country:US
Mailing Address - Phone:850-763-5409
Mailing Address - Fax:850-522-6103
Practice Address - Street 1:204 E 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4707
Practice Address - Country:US
Practice Address - Phone:850-763-5409
Practice Address - Fax:850-522-6103
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32871207RG0100X
FLME0098480207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I10621Medicare UPIN
AZ869480Medicare ID - Type Unspecified
AZZ82100Medicare PIN