Provider Demographics
NPI:1528132578
Name:WHEELER, ROBERT ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROSS
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5693
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0693
Mailing Address - Country:US
Mailing Address - Phone:541-912-8287
Mailing Address - Fax:541-684-9210
Practice Address - Street 1:350 LOMA LINDA LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2700
Practice Address - Country:US
Practice Address - Phone:541-912-8287
Practice Address - Fax:541-684-9210
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22243-0Medicaid