MEDICARE: DR. GARY ANDREW WHEELER M.D.

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
1	207R00000X	Internal Medicine Physician	MD049307L	PA

General Provider Information

NPI Number	:	1265490825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY ANDREW WHEELER M.D.

Provider Business Mailing Address
First Line	:	3996 LEACH LAKE WAY
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-1513
Country	:	US
Telephone Number	:	760-380-3110
Fax Number	:	760-380-6294

Provider Business Practice Location Address
First Line	:	BLDG 136
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310
Country	:	US
Telephone Number	:	760-380-3110
Fax Number	:	760-380-6294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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