Provider Demographics
NPI:1255383121
Name:WHEELER, DAVID T (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9735 SW SHADY LANE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-635-4436
Mailing Address - Fax:503-635-7356
Practice Address - Street 1:9735 SW SHADY LANE
Practice Address - Street 2:SUITE 203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-635-4436
Practice Address - Fax:503-635-7356
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD20807207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150538Medicaid
180040678OtherRAILROAD MEDICARE
OR107543Medicare ID - Type Unspecified
W20355Medicare UPIN