Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G0280 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G0280 | TX |
NPI | 1134218779 |
---|---|
Provider Name | Glenn Stephen Wheeless |
First Address | Carrollton, TX 75010-4615 |
Second Address | Carrollton, TX 75010-4615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 22/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123405606 | (05) | TX |
6484850003 | MEDICARE NSC - EFFECT 02/01/2011 (01) | TX |
8B7873 | BLUE CROSS BLUE SHIELD (01) | TX |
8CR163 | BCBS TX 02/01/2011 (01) | TX |
B27531 | (02) | TX |
P00935338 | RAILROAD MEDICARE (01) | TX |
TXB126769 | MEDICARE PART B - EFFECT. 4-20-11 (01) | TX |