Provider Demographics
NPI:1225469935
Name:BULL, WESLEY RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:RYAN
Last Name:BULL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 S. MIDLOTHIAN PARKWAY SUITE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065
Mailing Address - Country:US
Mailing Address - Phone:469-800-9600
Mailing Address - Fax:469-800-9610
Practice Address - Street 1:1441 S. MIDLOTHIAN PARKWAY SUITE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:469-800-9600
Practice Address - Fax:469-800-9610
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical