Provider Demographics
NPI:1669598520
Name:WHEELER, FREDRIC R (DO)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:R
Last Name:WHEELER
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2817 MC CLELLAND BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1629
Mailing Address - Country:US
Mailing Address - Phone:417-782-5522
Mailing Address - Fax:417-206-9599
Practice Address - Street 1:2817 MC CLELLAND BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1629
Practice Address - Country:US
Practice Address - Phone:417-782-5522
Practice Address - Fax:417-206-9599
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MOR5P772080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07317Medicare UPIN