Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 11342 | NH |
NPI | 1033110523 |
---|---|
Provider Name | Maynard B Wheeler |
First Address | Concord, NH 03301-2588 |
Second Address | Concord, NH 03301-2588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 17/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01Y003547NH01 | ANTHEM (01) | NH |
30201794 | (05) | NH |
330443 | CIGNA (01) | NH |
C59560 | (02) |