Provider Demographics
NPI:1376630251
Name:WHEELER, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:WHEELER
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:2716 TIBBETS DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6915
Practice Address - Country:US
Practice Address - Phone:817-571-6644
Practice Address - Fax:817-685-7951
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116930201Medicaid
TX4585043OtherAETNA PIN
TX7243159OtherCIGNA PIN
TX773458OtherFIRSTHEALTH PIN
TX1182053OtherUHC PIN
TX146488100OtherFIRSTCARE PIN
TX140442817Medicaid
1480369203OtherGRP NPI NUMBER
TX140442818Medicaid
TX140442861Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TXWHEJF94233OtherCCHIP PIN
TX116930202Medicaid
TX85391XOtherBCBSTX IND PIN
TX140442818Medicaid