Provider Demographics
NPI:1437405875
Name:WESLEY T. MYERS, MD PA
Entity type:Organization
Organization Name:WESLEY T. MYERS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-539-8115
Mailing Address - Street 1:100 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-539-8115
Mailing Address - Fax:936-539-8118
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 213
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-539-8115
Practice Address - Fax:936-539-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4387174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10149037OtherDPS
M4387OtherLICENSE
FM1915365OtherDEA
10149037OtherDPS
TXTXB1630405Medicare PIN