Provider Demographics
NPI:1427045814
Name:WHEAT-SIPES, M. ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:ASHLEY
Last Name:WHEAT-SIPES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7843 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5505
Mailing Address - Country:US
Mailing Address - Phone:318-212-3937
Mailing Address - Fax:318-212-3769
Practice Address - Street 1:7843 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5505
Practice Address - Country:US
Practice Address - Phone:318-212-3937
Practice Address - Fax:318-212-3769
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025707207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1041998Medicaid
4J683Medicare ID - Type Unspecified
LA1041998Medicaid