Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME74121 | FL |
NPI | 1003878877 |
---|---|
Provider Name | Wesley H. Faunce III |
First Address | Cape Coral, FL 33909-2253 |
Second Address | Cape Coral, FL 33909-2278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13347 | BCBS (01) | FL |
2642379-00 | (05) | FL |