Provider Demographics
NPI:1972582237
Name:WEDDLE, JOHN PALMER (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PALMER
Last Name:WEDDLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 WE KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6248
Mailing Address - Country:US
Mailing Address - Phone:479-709-8686
Mailing Address - Fax:479-709-8687
Practice Address - Street 1:301 S J T STITES ST
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9302
Practice Address - Country:US
Practice Address - Phone:918-775-9159
Practice Address - Fax:479-709-8687
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1681207P00000X
OK3297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR930089348OtherRR MEDICARE
OK100077380AMedicaid
AR134699003Medicaid
AR5K787OtherBLUECROSS BLUESHIELD
AR930089348OtherRR MEDICARE
5K787Medicare PIN
AR134699003Medicaid