Healthcare Provider Details

I. General information

NPI: 1013984251
Provider Name (Legal Business Name): WESLEY M STOTLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

IV. Provider business mailing address

4802 S 109TH E AVENUE
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-1400
  • Fax: 918-392-1488
Mailing address:
  • Phone: 918-392-1400
  • Fax: 918-392-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number3496
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: