Provider Demographics
NPI:1003897208
Name:WHEAT, PATRICK T (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:T
Last Name:WHEAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242B KEYSER AVE
Mailing Address - Street 2:SUITE 163
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5102
Mailing Address - Country:US
Mailing Address - Phone:318-356-0220
Mailing Address - Fax:
Practice Address - Street 1:242B KEYSER AVE
Practice Address - Street 2:SUITE 163
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5102
Practice Address - Country:US
Practice Address - Phone:318-356-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0213802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG07817Medicare UPIN
LA5W277Medicare ID - Type Unspecified