Provider Demographics
NPI:1598004673
Name:DOVE, WESLEY (MED)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:
Last Name:DOVE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4628
Mailing Address - Country:US
Mailing Address - Phone:864-529-1095
Mailing Address - Fax:864-577-7586
Practice Address - Street 1:355 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4628
Practice Address - Country:US
Practice Address - Phone:864-529-1095
Practice Address - Fax:864-577-7586
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator