Provider Demographics
NPI:1073585188
Name:CLARKSON, WESLEY ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ALLEN
Last Name:CLARKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MCCULLOUGH AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4046
Mailing Address - Country:US
Mailing Address - Phone:210-408-1613
Mailing Address - Fax:210-408-1613
Practice Address - Street 1:1715 MCCULLOUGH AVE
Practice Address - Street 2:FL 2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4046
Practice Address - Country:US
Practice Address - Phone:210-408-1613
Practice Address - Fax:210-408-1613
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010420207RC0000X
TXN4356207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288295301Medicaid
TX8DC182OtherBCBS
TXB143141Medicare PIN