Basic Information
| Provider Information | |||||||||
| NPI: | 1669643433 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESLEY D. FOREMAN, MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 202846 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787202846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123635779 | ||||||||
| FaxNumber: | 5122924458 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 RED RIVER ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123635779 | ||||||||
| FaxNumber: | 5122924458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOREMAN | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | DARRELL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5129707246 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | L6895 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1548316706 | 01 | TX | INDIVIDUAL NPI | OTHER |