Provider Demographics
NPI:1710962634
Name:WHEASLER, RAY S III (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:S
Last Name:WHEASLER
Suffix:III
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 1:5510 NIKE DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9081
Mailing Address - Country:US
Mailing Address - Phone:614-529-4260
Mailing Address - Fax:614-529-4270
Practice Address - Street 1:5510 NIKE DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9081
Practice Address - Country:US
Practice Address - Phone:614-529-4260
Practice Address - Fax:614-529-4270
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618264Medicaid
OHI21794Medicare UPIN