Healthcare Provider Details

I. General information

NPI: 1861481012
Provider Name (Legal Business Name): DONALD EVERETT WESSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST 4C201
LUBBOCK TX
79430-0002
US

IV. Provider business mailing address

PO BOX 5865
LUBBOCK TX
79408-5865
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3150
  • Fax: 806-743-3148
Mailing address:
  • Phone: 806-743-2898
  • Fax: 806-743-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberF2102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: