Provider Demographics
NPI:1538149331
Name:WESLEY, JON MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:MARK
Last Name:WESLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:80 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4453
Mailing Address - Country:US
Mailing Address - Phone:407-648-4323
Mailing Address - Fax:407-648-0968
Practice Address - Street 1:80 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4453
Practice Address - Country:US
Practice Address - Phone:407-648-4323
Practice Address - Fax:407-648-0968
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME869112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL293206OtherAVMED ID NUMBER
FL0198229OtherGHI ID NUMBER
FL2472671OtherUNITED ID NUMBER
FL3345832OtherAETNA HMO ID NUMBER
FL2349397OtherUNITED ID NUMBER
FL7838462OtherCIGNA ID NUMBER
FL7901553OtherAETNA PPO ID NUMBER
FL81739OtherBC/BS OF FL ID NUMBER
FLN231876OtherWELLCARE ID NUMBER
FLP00150060OtherRAILROAD MEDICARE ID NUMB
FL270571100Medicaid
FLP00150060OtherRAILROAD MEDICARE ID NUMB
FL2349397OtherUNITED ID NUMBER
FL293206OtherAVMED ID NUMBER