Provider Demographics
NPI:1760714034
Name:EADES, WESLEY M (AP, DOM)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:M
Last Name:EADES
Suffix:
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10595 COUNTY ROAD 229
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-3360
Mailing Address - Country:US
Mailing Address - Phone:407-300-5542
Mailing Address - Fax:
Practice Address - Street 1:10595 COUNTY ROAD 229
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-3360
Practice Address - Country:US
Practice Address - Phone:407-300-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist