Provider Demographics
NPI:1053379677
Name:YEACKLE, WESLEY OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:OWEN
Last Name:YEACKLE
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 1:4263 OCEANSIDE BLVD
Mailing Address - Street 2:SUITE #106-163
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3479
Mailing Address - Country:US
Mailing Address - Phone:760-277-5214
Mailing Address - Fax:
Practice Address - Street 1:4263 OCEANSIDE BLVD
Practice Address - Street 2:SUITE #106-163
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3479
Practice Address - Country:US
Practice Address - Phone:760-277-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056653A2083A0100X, 2083P0011X
CAC129122207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine