Provider Demographics
NPI:1952467367
Name:MAYER, WESLEY A (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:A
Last Name:MAYER
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 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-6455
Mailing Address - Fax:713-790-4456
Practice Address - Street 1:1327 LAKE POINTE PKWY STE 305
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4394
Practice Address - Country:US
Practice Address - Phone:171-379-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186259208800000X
TXN6487208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01063002OtherRAILROAD MEDICARE
TX220286303Medicaid
TX1952467367OtherBLUE CROSS BLUE SHIELD
TX220286302Medicaid
TXP00993703OtherRR MEDICARE
TXTXB151387Medicare PIN
TX1952467367OtherBLUE CROSS BLUE SHIELD