Provider Demographics
NPI:1336422955
Name:WELLINGTON, BRIAN D (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:WELLINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:270-844-8183
Practice Address - Street 1:1300 MERRITT DR STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2788
Practice Address - Country:US
Practice Address - Phone:270-844-8027
Practice Address - Fax:270-844-8183
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03760207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK167701Medicare PIN