Provider Demographics
NPI:1023033719
Name:WILEY, HENRY E III (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:E
Last Name:WILEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:916 S GOLF VIEW ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5222
Mailing Address - Country:US
Mailing Address - Phone:813-251-3906
Mailing Address - Fax:
Practice Address - Street 1:1425 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3126
Practice Address - Country:US
Practice Address - Phone:813-253-2635
Practice Address - Fax:813-254-7142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0025943207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30189AMedicare PIN