Provider Demographics
NPI:1053623884
Name:UPDIKE, WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:UPDIKE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15495 N 247 RD
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-7969
Mailing Address - Country:US
Mailing Address - Phone:918-733-1351
Mailing Address - Fax:866-611-2680
Practice Address - Street 1:15495 N 247 RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-7969
Practice Address - Country:US
Practice Address - Phone:918-733-1351
Practice Address - Fax:866-611-2680
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34806208M00000X, 207Q00000X
LAMD.208189207Q00000X
TXR0668207P00000X, 207Q00000X
OK29066207Q00000X
IN01071413A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine