Provider Demographics
NPI:1487697561
Name:WHEAT, DAVID BRICE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRICE
Last Name:WHEAT
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 1:309 A MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056
Mailing Address - Country:US
Mailing Address - Phone:601-924-1877
Mailing Address - Fax:601-924-1871
Practice Address - Street 1:309 A MORRISON DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056
Practice Address - Country:US
Practice Address - Phone:601-924-1877
Practice Address - Fax:601-924-1871
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS201941681OtherBLUE CROSS BLUE SHIELD
MS201941681OtherUNITED HEALTH CARE
MS201941681OtherAETNA
MSP00250596 GRP DD7799OtherRAILROAD MEDICARE
MS0114637Medicaid
MSP00250596 GRP DD7799OtherRAILROAD MEDICARE
MSC72897Medicare UPIN