Provider Demographics
NPI:1558518688
Name:WHEATLEY, EVA LISA (DO)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:LISA
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N IH 35 STE 770
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1853
Mailing Address - Country:US
Mailing Address - Phone:512-482-8880
Mailing Address - Fax:
Practice Address - Street 1:14027 MEMORIAL DR # 252
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6826
Practice Address - Country:US
Practice Address - Phone:281-412-2494
Practice Address - Fax:281-412-2495
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM90932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine