Provider Demographics
NPI:1902972235
Name:WHEATON, MYRA A (MD , MPH)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:A
Last Name:WHEATON
Suffix:
Gender:F
Credentials:MD , MPH
Other - Prefix:
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Mailing Address - Street 1:1730 BELLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5701
Mailing Address - Country:US
Mailing Address - Phone:601-940-9785
Mailing Address - Fax:601-366-2698
Practice Address - Street 1:1730 BELLEWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5701
Practice Address - Country:US
Practice Address - Phone:601-940-9785
Practice Address - Fax:601-366-2698
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS17023207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology