Provider Demographics
NPI:1821002684
Name:GRIFFITT, WESLEY E (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:E
Last Name:GRIFFITT
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-3420
Mailing Address - Fax:
Practice Address - Street 1:1251 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3221
Practice Address - Country:US
Practice Address - Phone:321-434-3420
Practice Address - Fax:321-434-3423
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142989207T00000X
KS0426891207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105820800Medicaid
FLM6560OtherMEDICARE HFPSI
FLMC231OtherMEDICARE
WI35281800Medicaid
KS000A594Medicare ID - Type UnspecifiedMEDICARE KANSAS CITY
KS100828OtherBCBS KANSAS
WI026607650Medicare PIN
KS100397370AMedicaid