Provider Demographics
NPI:1205810025
Name:WHEELER, WILLIAM WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
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 1:229 S. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST. MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861
Mailing Address - Country:US
Mailing Address - Phone:208-245-5551
Mailing Address - Fax:208-245-5246
Practice Address - Street 1:229 S. 7TH STREET
Practice Address - Street 2:
Practice Address - City:ST. MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861
Practice Address - Country:US
Practice Address - Phone:208-245-5551
Practice Address - Fax:208-245-5246
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047560208600000X
IDM-11617208600000X
CO33639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8943921OtherLABOR & INDUSTRIES CRIME VICTIM
WA8943921OtherLABOR & INDUSTRIES CRIME VICTIM
WA8864350Medicare PIN
E70296Medicare UPIN
WA0218709OtherLABOR & INDUSTRIES