Provider Demographics
NPI:1134226749
Name:PARKHURST, WESLEY E JR (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:E
Last Name:PARKHURST
Suffix:JR
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 1:617 W TRUDGEON ST
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-4063
Mailing Address - Country:US
Mailing Address - Phone:918-652-4400
Mailing Address - Fax:918-652-9869
Practice Address - Street 1:617 W TRUDGEON ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-4063
Practice Address - Country:US
Practice Address - Phone:918-652-4400
Practice Address - Fax:918-652-9869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100252720DMedicaid
OK4415072U800UOtherBLUE CROSS BLUE SHIELD
OK$$$$$$$$$XMedicare PIN