Provider Demographics
NPI:1972752954
Name:PEMBERTON, WESLEY E (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:E
Last Name:PEMBERTON
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 1:2702 E 5TH ST STE 837
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5021
Mailing Address - Country:US
Mailing Address - Phone:903-213-5515
Mailing Address - Fax:888-518-2562
Practice Address - Street 1:2702 E 5TH ST STE 837
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5021
Practice Address - Country:US
Practice Address - Phone:903-213-5515
Practice Address - Fax:888-518-2562
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4658207P00000X, 207Q00000X
TXBP10032214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine