Provider Demographics
NPI:1487612966
Name:WELLS, MARY DUNLAP (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DUNLAP
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 SOUTH INGLESIDE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-928-1222
Mailing Address - Fax:251-928-2398
Practice Address - Street 1:150 SOUTH INGLESIDE
Practice Address - Street 2:STE 6
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-928-1222
Practice Address - Fax:251-928-2398
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00026769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932901Medicaid
I36494Medicare UPIN
AL051556345Medicare ID - Type Unspecified