Provider Demographics
NPI:1407988439
Name:WHEELER, JEFFREY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAY
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 1:2101 MARKET STREET
Mailing Address - Street 2:SUITE 524
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205
Mailing Address - Country:US
Mailing Address - Phone:303-809-2946
Mailing Address - Fax:303-927-6021
Practice Address - Street 1:2101 MARKET ST
Practice Address - Street 2:SUITE 524
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2004
Practice Address - Country:US
Practice Address - Phone:303-809-2946
Practice Address - Fax:303-927-6021
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190056208200000X
CO41687208200000X
CAG87689208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01897254Medicaid
NYG86595Medicare UPIN
NY39L751Medicare ID - Type Unspecified