Provider Demographics
NPI:1114238904
Name:WALES, DIRK OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:OLIVER
Last Name:WALES
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 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:281-727-3400
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:14TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:281-727-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine