Provider Demographics
NPI:1497959076
Name:MYERS, WESLEY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:THOMAS
Last Name:MYERS
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 1:100 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-539-8115
Mailing Address - Fax:936-539-8118
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-539-8115
Practice Address - Fax:936-539-8118
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM43872086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437405875OtherNPI 2