| Entity Name: | ROBERT L. R. WESLY, M.D., PH.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Aug 2001 (24 years ago) |
| Date of dissolution: | 15 Sep 2006 (18 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 15 Sep 2006 (18 years ago) |
| Document Number: | P01000078726 |
| FEI/EIN Number | 593737807 |
| Address: | 6510 NW 9TH AVENUE, SUITE 4, GAINESVILLE, FL, 32605, US |
| Mail Address: | 6718 SW 100TH LANE, GAINESVILLE, FL, 32608, US |
| ZIP code: | 32605 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1043407851 | 2007-09-26 | 2008-12-31 | 2251 NW 41ST ST, SUITE E, GAINESVILLE, FL, 326067498, US | 2251 NW 41ST ST, SUITE E, GAINESVILLE, FL, 326067498, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-377-6010 |
| Fax | 3523710039 |
Authorized person
| Name | DR. ROBERT L WESLY |
| Role | PRESIDENT/OWNER |
| Phone | 3523776010 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | ME44335 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2086X0206X - Surgical Oncology Physician |
| License Number | ME44335 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| License Number | ME44335 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | TRI-CARE |
| Number | 060066125 |
| State | FL |
| Issuer | AVMED |
| Number | 206847 |
| State | FL |
| Issuer | BC-BS |
| Number | 01375 |
| State | FL |
| Issuer | MEDICAID |
| Number | 068801100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WESLY ROBERT L. R | Agent | 6718 SW 100TH LANE, GAINESVILLE, FL, 32608 |
| Name | Role | Address |
|---|---|---|
| WESLY ROBERT L. R | President | 6718 SW 100TH LANE, GAINESVILLE, FL, 32608 |
| Name | Role | Address |
|---|---|---|
| WESLY ROBERT L. R | Owner | 6718 SW 100TH LANE, GAINESVILLE, FL, 32608 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| CANCEL ADM DISS/REV | 2005-08-11 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-08-11 | 6510 NW 9TH AVENUE, SUITE 4, GAINESVILLE, FL 32605 | No data |
| CHANGE OF MAILING ADDRESS | 2005-08-11 | 6510 NW 9TH AVENUE, SUITE 4, GAINESVILLE, FL 32605 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2002-09-11 | 6718 SW 100TH LANE, GAINESVILLE, FL 32608 | No data |
| REGISTERED AGENT NAME CHANGED | 2002-09-11 | WESLY, ROBERT L. RMD | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2005-08-11 |
| ANNUAL REPORT | 2003-09-09 |
| ANNUAL REPORT | 2002-09-11 |
| Domestic Profit | 2001-08-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
