Provider Demographics
NPI:1689651960
Name:WETZEL, ORVILLE R (MD)
Entity Type:Individual
Prefix:DR
First Name:ORVILLE
Middle Name:R
Last Name:WETZEL
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:PO BOX 47662
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7662
Mailing Address - Country:US
Mailing Address - Phone:316-685-3698
Mailing Address - Fax:316-652-0340
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:316-685-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24624207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102268OtherBCBS
KS1001462200BMedicaid
KS050089299OtherRAILROAD MEDICARE
KS1001462200BMedicaid
KS102268Medicare ID - Type Unspecified