Provider Demographics
NPI:1548394455
Name:WESLY, ROBERT L R (MD PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L R
Last Name:WESLY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1143 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4218
Practice Address - Country:US
Practice Address - Phone:352-377-6010
Practice Address - Fax:352-371-0039
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME443352086S0129X, 2086X0206X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060066125OtherTRICARE
FL206847OtherAVMED
FL01375OtherBC-BS
FL068801100Medicaid
FL068801100Medicaid
FL050107Medicare UPIN