Provider Demographics
NPI:1881606002
Name:POPE, WESLEY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:EDWARD
Last Name:POPE
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 892398
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-2398
Mailing Address - Country:US
Mailing Address - Phone:405-387-4546
Mailing Address - Fax:405-387-4551
Practice Address - Street 1:2818 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6576
Practice Address - Country:US
Practice Address - Phone:405-387-4546
Practice Address - Fax:405-387-4551
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK17440OtherSTATE LICENSE NUMBER
OK400522066OtherMEDICARE GROUP NO
OK100213760AMedicaid
OK22654OtherOKLAHOMA BUREAU OF NARCOTICS NUMBER
OK22654OtherOKLAHOMA BUREAU OF NARCOTICS NUMBER
OKOK17440OtherSTATE LICENSE NUMBER
OKF32702Medicare UPIN
OK100213760AMedicaid