Provider Demographics
NPI:1700887577
Name:DESSELLE, WESLEY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JOSEPH
Last Name:DESSELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407 DEPT 5839
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:256-386-1125
Mailing Address - Fax:888-745-7084
Practice Address - Street 1:PO BOX 11407
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35246-4932
Practice Address - Country:US
Practice Address - Phone:256-386-1125
Practice Address - Fax:888-745-7084
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.25005208600000X
LA00025005208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I029080OtherMEDICARE
AL114472Medicaid
AL511-13246OtherBCBS LINK TO SURGICAL ASSOC
AL1790879559Medicaid
AL511-89054OtherBCBS ECM HEALTH GROUP, LLC
AL196318Medicaid
AL529001490OtherMEDICAID LINK TO SURGICAL ASSOCIATES GROUP NUMBER
63-0962367OtherFEDERAL ID SURGICAL ASSOC
AL114472Medicaid
AL1790879559Medicaid