Provider Demographics
NPI:1710951900
Name:SHEELER, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:SHEELER
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 1:10250 N 92ND ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4519
Mailing Address - Country:US
Mailing Address - Phone:480-470-0606
Mailing Address - Fax:480-304-3543
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4519
Practice Address - Country:US
Practice Address - Phone:480-470-0606
Practice Address - Fax:480-304-3543
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33644207Q00000X
AZ52719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN182283700Medicaid
MN182283700Medicaid
MN080001726Medicare ID - Type Unspecified
MN080017249Medicare ID - Type UnspecifiedRAILROAD