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Individual

GLENN STEPHEN WHEELESS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4780 N JOSEY LN, CARROLLTON, TX 75010-4615
(972) 492-1334
(972) 492-5174
Mailing address
4780 N JOSEY LN, CARROLLTON, TX 75010-4615
(972) 492-1334
(972) 492-5174

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G0280
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
G0280
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
123405606
TX
01
6484850003
MEDICARE NSC - EFFECT 02/01/2011
TX
01
8B7873
BLUE CROSS BLUE SHIELD
TX
01
8CR163
BCBS TX 02/01/2011
TX
01
P00935338
RAILROAD MEDICARE
TX
01
TXB126769
MEDICARE PART B - EFFECT. 4-20-11
TX
Enumeration date
10/12/2006
Last updated
05/22/2013
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