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General NPI Number Information
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NPI Number | 1760415608
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Entity Type | Individual
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Provider Name | BENTON M WHEELER MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 504 AZALEA DR STE A
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City | OXFORD
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State | MS
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Zip | 38655-5397
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Country | US
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Telephone | 662-236-7738
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Fax | 662-236-9642
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 103
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City | MEMPHIS
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State | TN
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Zip | 38120-9446
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Country | US
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Telephone |
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Fax | 901-227-8591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 13608
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | E3440
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 24391
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License Number State | TN
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