Provider Demographics
NPI:1225040819
Name:WESSLER, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:WESSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2414
Mailing Address - Country:US
Mailing Address - Phone:228-863-7115
Mailing Address - Fax:228-863-2723
Practice Address - Street 1:1118 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2414
Practice Address - Country:US
Practice Address - Phone:228-863-7115
Practice Address - Fax:228-863-2723
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08501207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017339Medicaid
MS00017339Medicaid
MSB64594Medicare UPIN