Provider Demographics
NPI:1306047469
Name:WELLS, BRENDA SUE (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SUE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2918 E BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4016
Mailing Address - Country:US
Mailing Address - Phone:417-833-1100
Mailing Address - Fax:417-720-1132
Practice Address - Street 1:2918 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-833-1100
Practice Address - Fax:417-720-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2019-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO107139207Q00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF26328Medicare UPIN