Provider Demographics
NPI:1184228306
Name:MAYEUX, WESLEY JOB (RDN, LD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:JOB
Last Name:MAYEUX
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MUTT YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-1987
Mailing Address - Country:US
Mailing Address - Phone:936-668-1581
Mailing Address - Fax:
Practice Address - Street 1:190 MUTT YOUNG RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-1987
Practice Address - Country:US
Practice Address - Phone:936-668-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86108438133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered