Provider Demographics
NPI:1174879159
Name:WHEELOCK, BRECK JAMES (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRECK
Middle Name:JAMES
Last Name:WHEELOCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3104 ROCKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4625
Mailing Address - Country:US
Mailing Address - Phone:562-846-8191
Mailing Address - Fax:
Practice Address - Street 1:1202 E ARAPAHO RD STE 122
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2400
Practice Address - Country:US
Practice Address - Phone:469-250-4422
Practice Address - Fax:469-250-7068
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA11268363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty