Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 11228 | TX |
Y | 213ER0200X | Radiology | 11228 | TX |
NPI | 1245233659 |
---|---|
Provider Name | Dr. Wesley R Duval |
First Address | Southlake, TX 76092-7109 |
Second Address | Southlake, TX 76092-7109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 20/06/2017 |