Provider Demographics
NPI:1952402430
Name:HALL, WESLEY WALKER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:WALKER
Last Name:HALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:635 SIERRA ROSE DR.
Mailing Address - Street 2:STE. A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2079
Mailing Address - Country:US
Mailing Address - Phone:775-284-8296
Mailing Address - Fax:775-332-6583
Practice Address - Street 1:635 SIERRA ROSE DR.
Practice Address - Street 2:STE. A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2079
Practice Address - Country:US
Practice Address - Phone:775-284-8296
Practice Address - Fax:775-332-6583
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9073208200000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016842Medicaid
G90622Medicare UPIN
NV33870Medicare ID - Type Unspecified