Provider Demographics
NPI:1134178452
Name:ACKER, WESLEY GLENN (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:GLENN
Last Name:ACKER
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 1:2701 SUNSET RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0007
Mailing Address - Country:US
Mailing Address - Phone:972-772-5450
Mailing Address - Fax:972-772-5452
Practice Address - Street 1:2701 SUNSET RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0007
Practice Address - Country:US
Practice Address - Phone:972-772-5450
Practice Address - Fax:972-772-5452
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M2961OtherBCBSTX
TX1717407-04Medicaid
TX8D6970Medicare PIN
TX8M2961OtherBCBSTX
TX1717407-04Medicaid
TXP00287445Medicare PIN