Healthcare Provider Details

I. General information

NPI: 1275531683
Provider Name (Legal Business Name): ANTHONY WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BRANSON LANDING BLVD
BRANSON MO
65616-2052
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-7000
  • Fax:
Mailing address:
  • Phone: 417-875-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2001017188
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME76944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: