Provider Demographics
NPI:1548487127
Name:WESLEY, BRUCE ELBERT SR (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ELBERT
Last Name:WESLEY
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:203 E REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1291
Mailing Address - Country:US
Mailing Address - Phone:559-585-1515
Mailing Address - Fax:
Practice Address - Street 1:869 W LACEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4328
Practice Address - Country:US
Practice Address - Phone:559-582-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant