Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ACN 586 | FL |
NPI | 1003157017 |
---|---|
Provider Name | Dr. Tomas Wharton |
First Address | Homestead, FL 33030-4734 |
Second Address | Homestead, FL 33030-4734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2013 |
Last Update Date | 21/04/2015 |