Basic Information
| Provider Information | |||||||||
| NPI: | 1891790309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRIGGERS | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 WEXFORD WAY | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321294108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867671187 | ||||||||
| FaxNumber: | 3863040682 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 DUNLAWTON AVE | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321274901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867631000 | ||||||||
| FaxNumber: | 3863040682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME86068 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ME86068 | 01 | FL | UNITED BENEFITS | OTHER | 57727 | 01 | FL | BLUE CROSS BLUE SHIELD ID | OTHER | 265807100 | 05 | FL | MEDICAID | ME86068 | 01 | FL | VOLUSIA HEALTH NETWORK | OTHER | ME86068 | 01 | FL | DCWO | OTHER |