Provider Demographics
NPI:1043309891
Name:SUFFICOOL, WESLEY L (DO)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:L
Last Name:SUFFICOOL
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 1:211 FOUNDERS PARK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8099
Mailing Address - Country:US
Mailing Address - Phone:605-791-5553
Mailing Address - Fax:605-791-5644
Practice Address - Street 1:211 FOUNDERS PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8099
Practice Address - Country:US
Practice Address - Phone:605-791-5553
Practice Address - Fax:605-791-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4023208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00416084OtherRR MEDICARE
SDP00416084OtherRR MEDICARE
F34114Medicare UPIN