Healthcare Provider Details

I. General information

NPI: 1811504814
Provider Name (Legal Business Name): JEREMY WHEELER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JEREMY WHEELER LMT

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 NW FAIRVIEW DR # A
GRESHAM OR
97030-3842
US

IV. Provider business mailing address

1748 NW FAIRVIEW DR # A
GRESHAM OR
97030-3842
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-3910
  • Fax:
Mailing address:
  • Phone: 503-492-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number10440
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: