Provider Demographics
NPI:1144275348
Name:WESLEY, ROBERT T (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:WESLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-586-1969
Mailing Address - Fax:270-586-1914
Practice Address - Street 1:1112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2371
Practice Address - Country:US
Practice Address - Phone:270-586-1969
Practice Address - Fax:270-586-1914
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I26361Medicare UPIN
KY00305001Medicare PIN