Provider Demographics
NPI:1548226632
Name:THOMAS, WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:THOMAS
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 1:623 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-2129
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:1511 HIGHWAY 25B
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-1701
Practice Address - Country:US
Practice Address - Phone:501-362-9426
Practice Address - Fax:501-362-9456
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139081001Medicaid
AR5L324Medicare PIN
AR139081001Medicaid
AR57297Medicare PIN