Provider Demographics
NPI:1912958588
Name:VALDES, WESLEY N (DO)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:N
Last Name:VALDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-935-4210
Mailing Address - Fax:813-932-7940
Practice Address - Street 1:3000 MEDICAL PARK DR STE 430
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4681
Practice Address - Country:US
Practice Address - Phone:813-615-7160
Practice Address - Fax:813-615-7173
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14248207R00000X
FLOS176642083P0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I23858Medicare UPIN
BV8596136OtherDEA #