Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 01078016A | IN |
NPI | 1265876213 |
---|---|
Provider Name | John Len Wheat |
First Address | West Terre Haute, IN 47885-9368 |
Second Address | Terre Haute, IN 47807-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 13/04/2021 |