Basic Information
| Provider Information | |||||||||
| NPI: | 1265564009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 COOPER POINT RD SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985025736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604866710 | ||||||||
| FaxNumber: | 3607050269 | ||||||||
| Practice Location | |||||||||
| Address1: | 1620 COOPER POINT RD SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985025736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604866710 | ||||||||
| FaxNumber: | 3607050269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60889819 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.