Individual
MR. JACOB WHEELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
925 HIGHLAND BLVD STE 1100, BOZEMAN, MT 59715-6900
(406) 414-4550
Mailing address
915 HIGHLAND BLVD, ATTN PFS CREDENTIALING, BOZEMAN, MT 59715-6902
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
79505
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174973564
—
MT
Enumeration date
06/15/2016
Last updated
04/09/2025
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