Provider Demographics
NPI:1528164621
Name:WELLS, SARA A (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2131 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1128
Mailing Address - Country:US
Mailing Address - Phone:801-474-0355
Mailing Address - Fax:801-485-8007
Practice Address - Street 1:2131 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1128
Practice Address - Country:US
Practice Address - Phone:801-474-0355
Practice Address - Fax:801-485-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT953098541205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT080131162OtherRAILROAD MEDICARE
UT$$$$$$$$$006Medicaid
UT000066406Medicare PIN
UT000011885Medicare ID - Type Unspecified
G44976Medicare UPIN
000066405Medicare PIN