Provider Demographics
NPI:1164413845
Name:ST CLAIR, WESLEY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:SCOTT
Last Name:ST CLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:579 GREENWAY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4809
Mailing Address - Country:US
Mailing Address - Phone:828-262-0100
Mailing Address - Fax:828-264-7592
Practice Address - Street 1:579 GREENWAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4809
Practice Address - Country:US
Practice Address - Phone:828-262-0100
Practice Address - Fax:828-264-7592
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12-00942OtherUNITED HEALTH CARE
NC132NMOtherNC HEALTH CHOICE
NC89132NMMedicaid
NC132NMOtherBLUE CROSS/BLUE SHIELD
NC132NMOtherFEDERAL EMPLOYEES
NC62308-NOCDOtherCIGNA
NC132NMOtherSTATE HEALTH PLAN
NCB8412OtherMEDCOST
NCH94610Medicare UPIN