Provider Demographics
NPI:1588922561
Name:RYAN D WELLS MD PC
Entity type:Organization
Organization Name:RYAN D WELLS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-347-6715
Mailing Address - Street 1:3901 LAS POSAS RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-388-2068
Mailing Address - Fax:805-484-7700
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE 17
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-388-2068
Practice Address - Fax:805-484-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty