Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | H0927 | TX |
NPI | 1124241435 |
---|---|
Provider Name | Dr. Darrell Stafford Wheeler |
First Address | Waco, TX 76708-2368 |
Second Address | Waco, TX 76712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 19/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110419201 | (05) | TX |
E36589 | (02) | TX |