Organization
WATERFORD FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAMMY J WELLS M.D. (OWNER)
(563) 355-9990
Entity
Organization
Contact information
Practice address
1820 E 54TH ST, STE B, DAVENPORT, IA 52807-2797
(563) 355-9990
(563) 355-9999
Mailing address
1820 E 54TH ST, STE B, DAVENPORT, IA 52807-2797
(563) 355-9990
(563) 355-9999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1093794968
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49490
BLUE SHIELD
IA
05
—
7100883
—
IA
Enumeration date
03/06/2008
Last updated
03/06/2008
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