Provider Demographics
NPI:1508863101
Name:HERMAN, WESLEY K (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:K
Last Name:HERMAN
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 1:5421 LA SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4107
Mailing Address - Country:US
Mailing Address - Phone:214-361-1443
Mailing Address - Fax:214-368-8365
Practice Address - Street 1:5421 LA SIERRA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4107
Practice Address - Country:US
Practice Address - Phone:214-361-1443
Practice Address - Fax:214-368-8365
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16839Medicare UPIN
TX80E661Medicare PIN