Provider Demographics
NPI:1043407851
Name:ROBERT L R WESLY M D PH D P A
Entity Type:Organization
Organization Name:ROBERT L R WESLY M D PH D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD-PHD
Authorized Official - Phone:352-377-6010
Mailing Address - Street 1:2251 NW 41ST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7498
Mailing Address - Country:US
Mailing Address - Phone:352-377-6010
Mailing Address - Fax:352-371-0039
Practice Address - Street 1:2251 NW 41ST ST
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7498
Practice Address - Country:US
Practice Address - Phone:352-377-6010
Practice Address - Fax:352-371-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME443352086S0129X, 2086X0206X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060066125OtherTRI-CARE
FL206847OtherAVMED
FL01375OtherBC-BS
FL068801100Medicaid
FL060066125OtherTRI-CARE