Healthcare Provider Details

I. General information

NPI: 1972595759
Provider Name (Legal Business Name): CARROL E WHEAT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6206 WEST BELL ROAD SUITE 5
GLENDALE AZ
85308
US

IV. Provider business mailing address

2500 W UTOPIA RD STE. 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 602-375-5440
  • Fax: 623-516-0950
Mailing address:
  • Phone: 602-214-6148
  • Fax: 602-214-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1642
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: