Provider Demographics
NPI:1528285616
Name:WELLS, BRUCE W (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
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 1:1300 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2407
Mailing Address - Country:US
Mailing Address - Phone:620-221-2300
Mailing Address - Fax:620-221-3594
Practice Address - Street 1:1300 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2407
Practice Address - Country:US
Practice Address - Phone:620-221-2300
Practice Address - Fax:620-221-3594
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0413320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014013OtherBLUE SHIELD
KSD05310Medicare UPIN
KS014013Medicare ID - Type Unspecified