1588621908 NPI number — ROBERT H WHARTON JR. MD

Table of content: ROBERT H WHARTON JR. MD (NPI 1588621908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588621908 NPI number — ROBERT H WHARTON JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHARTON
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588621908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 EXECUTIVE DR STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-5323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-347-0005
Provider Business Mailing Address Fax Number:
727-541-6558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4855 1ST AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33713-8107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-321-6450
Provider Business Practice Location Address Fax Number:
727-327-2668
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME24918 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 037655800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410013097 . This is a "RAILROAD MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55065 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".