Provider Demographics
NPI:1730152059
Name:WESLEY, RAYMOND JASON JR (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JASON
Last Name:WESLEY
Suffix:JR
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 1:333 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-822-6514
Mailing Address - Fax:615-824-9223
Practice Address - Street 1:333 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-822-6514
Practice Address - Fax:615-824-9223
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010652207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2009304OtherBC
3168376Medicare ID - Type Unspecified
D70222Medicare UPIN