Provider Demographics
NPI:1770549545
Name:SCOLES, WESLEY DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:DOUGLAS
Last Name:SCOLES
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 1:1549 S. JEFFERSON STEET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344
Mailing Address - Country:US
Mailing Address - Phone:850-997-0707
Mailing Address - Fax:850-997-6833
Practice Address - Street 1:1549 SOUTH JEFFERSON STEET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344
Practice Address - Country:US
Practice Address - Phone:850-997-0707
Practice Address - Fax:850-997-6833
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253056200Medicaid
FL253056200Medicaid
FL41856Medicare PIN