Provider Demographics
NPI:1649290503
Name:WHEELER, ERVIN S (MD)
Entity type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:S
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 1:9894 LA JOLLA FARMS RD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1135
Mailing Address - Country:US
Mailing Address - Phone:858-245-6550
Mailing Address - Fax:858-452-9910
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-245-6550
Practice Address - Fax:858-452-9910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEU012ZOtherPTAN
CAA90675Medicare UPIN