Provider Demographics
NPI:1316920747
Name:WHEELER, ROSS C (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:C
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5418
Mailing Address - Country:US
Mailing Address - Phone:407-599-7546
Mailing Address - Fax:407-599-7506
Practice Address - Street 1:451 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5418
Practice Address - Country:US
Practice Address - Phone:407-599-7546
Practice Address - Fax:407-599-7506
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 73845207N00000X, 207ND0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260896600Medicaid
220029792OtherRAILROAD MEDICARE
FL260896600Medicaid
G72674Medicare UPIN