Provider Demographics
NPI:1558571893
Name:WHEAT, SARAH ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:WHEAT
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:P.O. BOX 3038
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-3038
Mailing Address - Country:US
Mailing Address - Phone:318-212-8232
Mailing Address - Fax:318-212-4153
Practice Address - Street 1:2400 HOSPITAL DR STE 130
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2386
Practice Address - Country:US
Practice Address - Phone:318-212-7990
Practice Address - Fax:318-212-7995
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2010532080A0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071901Medicaid
LA4N222DE91Medicare PIN
LA4N222CP07Medicare PIN
LA1071901Medicaid
LA4N222DE77Medicare PIN