Provider Demographics
NPI:1396739504
Name:WHEELER, ERIC B (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:B
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 E FLORENCE BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4782
Mailing Address - Country:US
Mailing Address - Phone:520-836-8988
Mailing Address - Fax:520-836-7930
Practice Address - Street 1:1780 E FLORENCE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4782
Practice Address - Country:US
Practice Address - Phone:520-836-8988
Practice Address - Fax:520-836-7930
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69721Medicare ID - Type Unspecified
AZS39136Medicare UPIN