Basic Information
| Provider Information | |||||||||
| NPI: | 1811918741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOOLER | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | GORDON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 W PUEBLO ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931056206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056877336 | ||||||||
| FaxNumber: | 8056879491 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 W PUEBLO ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931056206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056877336 | ||||||||
| FaxNumber: | 8056879491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 09/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | A83721 | CA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208600000X | A83721 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0122X | A83721 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1811918741 | 05 | CA | MEDICAID | 00A837210 | 01 | CA | BLUE SHIELD PROV. NUMBER | OTHER | 00A837210 | 05 | CA | MEDICAID |