Healthcare Provider Details

I. General information

NPI: 1013919752
Provider Name (Legal Business Name): JONATHAN W WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ADAMS ST STE 303
SAINT HELENA CA
94574-1173
US

IV. Provider business mailing address

999 ADAMS ST STE 303
SAINT HELENA CA
94574-1173
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-3658
  • Fax: 707-963-1775
Mailing address:
  • Phone: 707-963-3658
  • Fax: 707-963-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG68184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: