Basic Information
| Provider Information | |||||||||
| NPI: | 1780641795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 ADAMS ST SE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337420 | ||||||||
| FaxNumber: | 2565364109 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 ADAMS ST SE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337420 | ||||||||
| FaxNumber: | 2565364109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 19688 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 51026404 | 01 | AL | BCBS | OTHER | 51032723 | 01 | AL | BCBS | OTHER | D084 | 01 | AL | MEDICARE | OTHER | 51026774 | 01 | AL | BCBS | OTHER | E706 | 01 | AL | MEDICARE | OTHER | G423 | 01 | AL | MEDICARE | OTHER |