Provider Demographics
NPI:1578542015
Name:ASHABRANNER, WESLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:J
Last Name:ASHABRANNER
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 1:106 SOUTH 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543
Mailing Address - Country:US
Mailing Address - Phone:501-362-7538
Mailing Address - Fax:501-362-7143
Practice Address - Street 1:106 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543
Practice Address - Country:US
Practice Address - Phone:501-362-7538
Practice Address - Fax:501-362-7143
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5558208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120463729Medicaid
AR043804Medicare Oscar/Certification
AR120463729Medicaid
AR50148Medicare PIN