MEDICARE: DR. WESLEY JAY DRIGGERS MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME86068	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME86068	OTHER	FL	UNITED BENEFITS
2	57727	OTHER	FL	BLUE CROSS BLUE SHIELD ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ME86068	OTHER	FL	VOLUSIA HEALTH NETWORK
5	ME86068	OTHER	FL	DCWO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891790309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY JAY DRIGGERS MD, PHD

Provider Business Mailing Address
First Line	:	1060 WEXFORD WAY
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4108
Country	:	US
Telephone Number	:	386-767-1187
Fax Number	:	386-304-0682

Provider Business Practice Location Address
First Line	:	740 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4901
Country	:	US
Telephone Number	:	386-763-1000
Fax Number	:	386-304-0682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/30/2009

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