Provider Demographics
NPI:1578629986
Name:DENNIS, WESLEY DON (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:DON
Last Name:DENNIS
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 1:7416 S COOPER ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7025
Mailing Address - Country:US
Mailing Address - Phone:817-962-0381
Mailing Address - Fax:817-962-0385
Practice Address - Street 1:7416 S COOPER ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-7025
Practice Address - Country:US
Practice Address - Phone:817-962-0381
Practice Address - Fax:817-962-0385
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ85132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130021032OtherRAILROAD MEDICARE
TX104647601Medicaid
TX083092901Medicaid
TX00J07HMedicare ID - Type UnspecifiedMEDICARE GROUP
TX8593J0Medicare ID - Type Unspecified
TX0A3566Medicare PIN
TXG67469Medicare UPIN