1871553578 NPI number — DEBORAH A WHEELER MD

Table of content: DEBORAH A WHEELER MD (NPI 1871553578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871553578 NPI number — DEBORAH A WHEELER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
DEBORAH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HACKETT
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871553578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 WELLINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-6129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-241-8013
Provider Business Mailing Address Fax Number:
970-241-1308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WELLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81501-8180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-242-3854
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2006

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: 207L00000X , with the licence number:  25720 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01257203 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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