Healthcare Provider Details

I. General information

NPI: 1528132578
Provider Name (Legal Business Name): ROBERT ROSS WHEELER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LOMA LINDA LN
EUGENE OR
97405-2700
US

IV. Provider business mailing address

PO BOX 5693
EUGENE OR
97405-0693
US

V. Phone/Fax

Practice location:
  • Phone: 541-912-8287
  • Fax: 541-684-9210
Mailing address:
  • Phone: 541-912-8287
  • Fax: 541-684-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12563
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier22243-0
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: