Provider Demographics
NPI:1588723316
Name:WHEELER, JONATHAN HOWARD (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HOWARD
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 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-642-1363
Mailing Address - Fax:949-642-1438
Practice Address - Street 1:351 HOSPITAL RD STE 611
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3508
Practice Address - Country:US
Practice Address - Phone:949-642-1363
Practice Address - Fax:949-642-1438
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist