Provider Demographics
NPI:1003029695
Name:WESELEY, STEPHEN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARTHUR
Last Name:WESELEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-0855
Mailing Address - Country:US
Mailing Address - Phone:970-453-7006
Mailing Address - Fax:970-453-7006
Practice Address - Street 1:439 WHITE CLOUD DRIVE
Practice Address - Street 2:SUNRISE RIDGE TOWNHOUSE 2
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-453-7006
Practice Address - Fax:970-453-7006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34439174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist