Provider Demographics
NPI:1699776732
Name:WHEELER, CLARENCE JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:JOSEPH
Last Name:WHEELER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1126 SLIDE RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5402
Mailing Address - Country:US
Mailing Address - Phone:806-793-8447
Mailing Address - Fax:806-687-0337
Practice Address - Street 1:1126 SLIDE RD
Practice Address - Street 2:4B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5402
Practice Address - Country:US
Practice Address - Phone:806-793-8447
Practice Address - Fax:806-687-0337
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7299174400000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120521303Medicaid
NM000G8915Medicaid
TX87E200OtherBC/BS
TX87E200OtherBC/BS
TXC23369Medicare UPIN