Individual
JAMES DUSTIN WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2868 CONCORD RD, HAVANA, FL 32333-4010
(850) 567-0759
Mailing address
3425 BANNERMAN RD STE 105-108, TALLAHASSEE, FL 32312-7062
(850) 567-0759
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CBC1252005
FL
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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