1801105507 NPI number — DR. JAIME K. WHEELER M.D.

Table of content: DR. JAIME K. WHEELER M.D. (NPI 1801105507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801105507 NPI number — DR. JAIME K. WHEELER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
JAIME
Provider Middle Name:
K.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHEELER
Provider Other First Name:
JAMIE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1801105507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1805
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89702-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-827-0111
Provider Business Mailing Address Fax Number:
775-883-4306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3690 GRANT DR
Provider Second Line Business Practice Location Address:
SUITE A2
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-5476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-827-0111
Provider Business Practice Location Address Fax Number:
775-883-4306
Provider Enumeration Date:
09/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  3479 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3479 . This is a "NEVADA STATE BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 13028964 . This is a "ABMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24457 . This is a "MINNESOTA BOARD OF MEDICAL PRACTICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: C38180 . This is a "THE MEDICAL BOARD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: D2627 . This is a "TEXAS MEDICAL BOARD" identifier . This identifiers is of the category "OTHER".




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