Provider Demographics
NPI:1376511014
Name:NORD, WESLEY J (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:J
Last Name:NORD
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 1:1115 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1013
Mailing Address - Country:US
Mailing Address - Phone:605-339-1783
Mailing Address - Fax:605-367-7157
Practice Address - Street 1:1115 E 20TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1013
Practice Address - Country:US
Practice Address - Phone:605-339-1783
Practice Address - Fax:605-367-7157
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5603390Medicaid
SDS1025Medicare PIN
SDS911Medicare PIN
SD5603390Medicaid