Healthcare Provider Details

I. General information

NPI: 1164468328
Provider Name (Legal Business Name): MARK D. WHEELER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ARIZONA HEALTH SCIENCES CENTER 1501 N. CAMPBELL AVE., #3341
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

ARIZONA HEALTH SCIENCES CENTER 1501 N. CAMPBELL AVE., #3341
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6077
  • Fax: 520-626-2881
Mailing address:
  • Phone: 520-626-6077
  • Fax: 520-626-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number21409
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: