Active NPI
James Dustin Wells
- Contractor
- Havana, FL
National Provider Identifier
1285115824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- CBC1252005
- Practice address
- 2868 Concord Rd
Havana, FL 32333-4010 - Phone
- (850) 567-0759
- NPI assigned
- Aug 22, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | CBC1252005 | FL | Primary |
Addresses
Primary practice location
2868 Concord Rd
Havana, FL 32333-4010
Mailing address
3425 Bannerman Rd Ste 105-108
Tallahassee, FL 32312-7062
Phone (850) 567-0759
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CBC1252005 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1285115824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3425 BANNERMAN RD STE 105-108",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323127062",
"telephone_number": "850-567-0759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2868 CONCORD RD",
"city": "HAVANA",
"state": "FL",
"postal_code": "323334010",
"telephone_number": "850-567-0759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "JAMES",
"middle_name": "DUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-22",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "CBC1252005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Havana, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.