MEDICARE: MR. RAYMOND DOUGLAS WHEAT III CRNP

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	363LF0000X	Family Nurse Practitioner	1-150680	AL

General Provider Information

NPI Number	:	1992438071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND DOUGLAS WHEAT III CRNP

Provider Business Mailing Address
First Line	:	1758 PARK PL STE 406
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1135
Country	:	US
Telephone Number	:	334-240-2348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1758 PARK PL STE 406
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1135
Country	:	US
Telephone Number	:	334-240-2348
Fax Number	:

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

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	07/06/2022

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