Basic Information
| Provider Information | |||||||||
| NPI: | 1073933297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEAT | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | GRIFFIN | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GRIFFIN | ||||||||
| OtherFirstName: | ERICA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 840026 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062126965 | ||||||||
| FaxNumber: | 8062126279 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791064136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062126604 | ||||||||
| FaxNumber: | 8062120355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2014 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | S1017 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.