Provider Demographics
NPI:1720250186
Name:WITTELES, WESLEY HOLBROOK (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:HOLBROOK
Last Name:WITTELES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 BLAKE WILBUR DRIVE
Mailing Address - Street 2:STANFORD CANCER CENTER
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5821
Mailing Address - Country:US
Mailing Address - Phone:650-723-5007
Mailing Address - Fax:650-724-5203
Practice Address - Street 1:875 BLAKE WILBUR DRIVE
Practice Address - Street 2:STANFORD CANCER CENTER
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5821
Practice Address - Country:US
Practice Address - Phone:650-723-5007
Practice Address - Fax:650-724-5203
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88702207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology