Healthcare Provider Details

I. General information

NPI: 1871553578
Provider Name (Legal Business Name): DEBORAH A WHEELER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH A HACKETT MD

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WELLINGTON AVE
GRAND JUNCTION CO
81501-8180
US

IV. Provider business mailing address

1120 WELLINGTON AVE SUITE 206
GRAND JUNCTION CO
81501-6129
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-3854
  • Fax:
Mailing address:
  • Phone: 970-241-8013
  • Fax: 970-241-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25720
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: