Provider Demographics
NPI:1871589713
Name:WHEAT, DANNY
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:
Last Name:WHEAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AMBLER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2216
Mailing Address - Country:US
Mailing Address - Phone:325-670-3338
Mailing Address - Fax:325-670-4078
Practice Address - Street 1:1401 AMBLER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2216
Practice Address - Country:US
Practice Address - Phone:325-670-3338
Practice Address - Fax:325-670-4078
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0904213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112212901Medicaid
TX6612580001Medicare NSC
TX89C862Medicare PIN
TX112212901Medicaid