Individual
DR. ADAM WELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 STATE ST, MCCALL, ID 83638-3704
(208) 634-2221
(208) 634-7112
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 634-2221
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M-12492
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568634855
—
ID
Enumeration date
03/27/2008
Last updated
02/11/2016
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