Provider Demographics
NPI:1558538496
Name:WHEELER, JEFFREY LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEWIS
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:RR 1 BOX 92
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MO
Mailing Address - Zip Code:65735-9712
Mailing Address - Country:US
Mailing Address - Phone:816-769-6678
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 92
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MO
Practice Address - Zip Code:65735-9712
Practice Address - Country:US
Practice Address - Phone:816-769-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 36415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine