Basic Information
| Provider Information | |||||||||
| NPI: | 1427366426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | CARY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMELTZER | ||||||||
| OtherFirstName: | CARY | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CLOVERDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954253204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076691806 | ||||||||
| FaxNumber: | 7078947820 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 TARMAN DR | ||||||||
| Address2: | |||||||||
| City: | CLOVERDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954253932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078944229 | ||||||||
| FaxNumber: | 7078942954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2010 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 20A12450 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 005614 | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.