Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A23042 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A23042 | CA |
NPI | 1184038960 |
---|---|
Provider Name | Orest Wesely |
First Address | Stockton, CA 95267-0506 |
Second Address | Stockton, CA 95219-1849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 19/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A23374 | (02) | CA |