Provider Demographics
NPI:1699650614
Name:BURKHALTER, WESLEY CHASE
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:CHASE
Last Name:BURKHALTER
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 1:216 HANNAH LN
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8647
Mailing Address - Country:US
Mailing Address - Phone:409-377-2129
Mailing Address - Fax:
Practice Address - Street 1:216 HANNAH LN
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-8647
Practice Address - Country:US
Practice Address - Phone:409-377-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT4600207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine