Provider Demographics
NPI:1538301882
Name:ERVIN S. WHEELER, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ERVIN S. WHEELER, M.D., A MEDICAL CORPORATION
Other - Org Name:ERVN S. WHEELER, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOKSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-697-0227
Mailing Address - Street 1:8690 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3057
Mailing Address - Country:US
Mailing Address - Phone:619-697-0227
Mailing Address - Fax:619-697-3970
Practice Address - Street 1:8690 CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3057
Practice Address - Country:US
Practice Address - Phone:619-697-0227
Practice Address - Fax:619-697-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20992208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20992OtherLICENSE NUMBER