Provider Demographics
NPI:1780707174
Name:DALE, WHEELER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WHEELER
Middle Name:JOHN
Last Name:DALE
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 1:5060 SW PHILOMATH BLVD
Mailing Address - Street 2:# 512
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3239
Mailing Address - Country:US
Mailing Address - Phone:541-250-9074
Mailing Address - Fax:
Practice Address - Street 1:901 SAINT MARYS DR STE 400
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0520
Practice Address - Country:US
Practice Address - Phone:812-485-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30108207RC0200X, 207RP1001X, 207RS0012X
ORMD25366207RC0200X, 207RP1001X
IN01081209A207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780707174Medicaid