Theron  W  Wells  Jr  MD
Contract Details
Plaza Medical Associates
Facility name
Provider ID
P000001841
Tax ID
630577126
Effective Date
3/1/1999
Last Updated
5/5/2014
Direct Contract
Yes
Term Date
7/8/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
279 West Main Street Suite 3
Dothan, AL 36301
United States
County
Houston
Phone
3347948587 (Phone)
Billing Details
Address
279 West Main Street
Suite 3
Dothan, AL 36301
Billing Phone
3347948587
Specialty Type
Ophthalmology
Map
Address