Individual
WESLEY KENNETH HAISTY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
21655
NC
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
21655
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199023000
—
WV
01
—
24812
MEDCOST
—
01
—
3499
PARTNERS
—
01
—
38262
BCBS
—
05
—
6023894
—
VA
05
—
8938262
—
NC
01
—
9953079
AETNA
—
05
—
Q21655
—
SC
Enumeration date
12/09/2005
Last updated
05/08/2008
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