Provider Demographics
NPI:1053416990
Name:WHEATLEY, KENNETH KNOX JR (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KNOX
Last Name:WHEATLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 294809
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4809
Mailing Address - Country:US
Mailing Address - Phone:830-896-2020
Mailing Address - Fax:830-792-2431
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-896-2020
Practice Address - Fax:830-792-2431
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF03512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology