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NPI Code Detail

MEDICARE: MR. BRECK JAMES WHEELOCK PA-C

MEDICARE: MR. BRECK JAMES WHEELOCK PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA11268TX

General Provider Information

NPI Number : 1174879159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRECK JAMES WHEELOCK PA-C
Provider Business Mailing Address
First Line : 3104 ROCKBROOK DR
Second Line :
City : PLANO
State : TX
Zip : 75074-4625
Country : US
Telephone Number : 562-846-8191
Fax Number :
Provider Business Practice Location Address
First Line : 1202 E ARAPAHO RD STE 122
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-2400
Country : US
Telephone Number : 469-250-4422
Fax Number : 469-250-7068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2012
Last Update Date : 12/12/2018

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Directions to “ MR. BRECK JAMES WHEELOCK PA-C” Practice Location

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