Provider Demographics
NPI:1013008416
Name:WHEELER, DAVID B (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 EAST 2ND STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2955
Mailing Address - Country:US
Mailing Address - Phone:307-265-4343
Mailing Address - Fax:307-234-6339
Practice Address - Street 1:1020 EAST 2ND STREET
Practice Address - Street 2:STE 100
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2955
Practice Address - Country:US
Practice Address - Phone:307-265-4343
Practice Address - Fax:307-234-6339
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7035A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121198600Medicaid
WY20241Medicare ID - Type Unspecified
WY121198600Medicaid