Provider Demographics
NPI:1992569636
Name:DORAN, WESLEY AUSTIN
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:AUSTIN
Last Name:DORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1101
Mailing Address - Country:US
Mailing Address - Phone:614-800-0167
Mailing Address - Fax:
Practice Address - Street 1:43 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1101
Practice Address - Country:US
Practice Address - Phone:614-800-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care