Healthcare Provider Details

I. General information

NPI: 1760714034
Provider Name (Legal Business Name): WESLEY M EADES AP, DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10595 COUNTY ROAD 229
OXFORD FL
34484-3360
US

IV. Provider business mailing address

10595 COUNTY ROAD 229
OXFORD FL
34484-3360
US

V. Phone/Fax

Practice location:
  • Phone: 407-300-5542
  • Fax:
Mailing address:
  • Phone: 407-300-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: