Provider Demographics
NPI:1174562748
Name:WHEELER, JEFFREY E (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 GOFF MOUNTAIN ROAD SUITE 15
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313
Mailing Address - Country:US
Mailing Address - Phone:304-776-7990
Mailing Address - Fax:304-776-7974
Practice Address - Street 1:314 GOFF MOUNTAIN ROAD SUITE 15
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313
Practice Address - Country:US
Practice Address - Phone:304-776-7990
Practice Address - Fax:304-776-7974
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00354213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6420033000Medicaid
WV6420033000Medicaid
WV4792680001Medicare NSC
WV0893602Medicare PIN
WV480034125Medicare PIN