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Individual

WENDELL LEE WELLS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1501 HILAND AVE, SUITE L-1, BURLEY, ID 83318-2682
(208) 678-8899
Mailing address
1501 HILAND AVE, SUITE L-1, BURLEY, ID 83318-2682

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4248
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010004744
BLUE SHIELD
ID
05
002556300
ID
01
4248-1
BLUE CROSS
ID
Enumeration date
06/12/2006
Last updated
10/18/2018
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