Provider Demographics
NPI:1568474831
Name:WHEELER, VERNON LEE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:LEE
Last Name:WHEELER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:FAMILY MEDICINE RESIDENCY
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5095
Mailing Address - Country:US
Mailing Address - Phone:254-288-8280
Mailing Address - Fax:254-286-7196
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:FAMILY MEDICINE RESIDENCY
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8280
Practice Address - Fax:254-286-7196
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-10-26
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Provider Licenses
StateLicense IDTaxonomies
MN48333207Q00000X
IL036.103688207Q00000X
NY223530-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN237903100Medicaid
MN85G58WHOtherBLUE CROSS/SHIELD
H50200Medicare UPIN