Provider Demographics
NPI:1891790309
Name:DRIGGERS, WESLEY JAY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JAY
Last Name:DRIGGERS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WEXFORD WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4108
Mailing Address - Country:US
Mailing Address - Phone:386-767-1187
Mailing Address - Fax:386-304-0682
Practice Address - Street 1:740 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4901
Practice Address - Country:US
Practice Address - Phone:386-763-1000
Practice Address - Fax:386-304-0682
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME86068OtherUNITED BENEFITS
FL57727OtherBLUE CROSS BLUE SHIELD ID
FL265807100Medicaid
FLME86068OtherVOLUSIA HEALTH NETWORK
FLME86068OtherDCWO
FL57727OtherBLUE CROSS BLUE SHIELD ID
FL265807100Medicaid