Provider Demographics
NPI:1871091538
Name:WELLS, DAVID LEE JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1256
Mailing Address - Country:US
Mailing Address - Phone:812-261-3175
Mailing Address - Fax:
Practice Address - Street 1:6585 BRANCHES DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7445
Practice Address - Country:US
Practice Address - Phone:812-261-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN17001479AOtherINDIANA PROFESSIONAL LICENSING AGENCY