Provider Demographics
NPI:1912986878
Name:MARNER, WESLEY DARRELL (DO)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:DARRELL
Last Name:MARNER
Suffix:
Gender:M
Credentials:DO
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 40
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36072-0040
Mailing Address - Country:US
Mailing Address - Phone:334-687-1973
Mailing Address - Fax:334-687-1972
Practice Address - Street 1:130 N RANDOLPH AVE
Practice Address - Street 2:B
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1631
Practice Address - Country:US
Practice Address - Phone:334-687-1973
Practice Address - Fax:334-687-1972
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000086452Medicaid
AL510-86452OtherBCBS PROVIDER NUMBER
AL510-86452OtherBCBS PROVIDER NUMBER
AL27-1814431OtherTAX ID NUMBER: DR MARNERS CLINIC LLC
AL000086452Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER