Provider Demographics
NPI:1952540403
Name:WHEELER, PAUL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
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:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-1059
Mailing Address - Country:US
Mailing Address - Phone:580-544-2501
Mailing Address - Fax:580-227-2882
Practice Address - Street 1:PO BOX 1059
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933-1059
Practice Address - Country:US
Practice Address - Phone:580-517-1057
Practice Address - Fax:888-651-9957
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF74678Medicare UPIN