Healthcare Provider Details

I. General information

NPI: 1578542015
Provider Name (Legal Business Name): WESLEY J ASHABRANNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SOUTH 7TH STREET
HEBER SPRINGS AR
72543
US

IV. Provider business mailing address

106 SOUTH 7TH STREET
HEBER SPRINGS AR
72543
US

V. Phone/Fax

Practice location:
  • Phone: 501-362-7538
  • Fax: 501-362-7143
Mailing address:
  • Phone: 501-362-7538
  • Fax: 501-362-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC5558
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: