Individual
DR. MICHAEL JOHN WHEATLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 N GRAHAM ST, SUITE 330, PORTLAND, OR 97227-1654
(503) 413-3650
(503) 413-3644
Mailing address
9440 NW LIGHTNING RIDGE DR, PORTLAND, OR 97229-2633
(503) 292-8062
(503) 608-4083
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
17999
OR
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
MD17999
OR
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
Primary
DR.0059470
CO
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
MD17999
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD17999
OREGON STATE LICENSE
OR
Enumeration date
08/19/2006
Last updated
10/23/2018
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