Basic Information
| Provider Information | |||||||||
| NPI: | 1003157017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHARTON | ||||||||
| FirstName: | TOMAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 NE 8TH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330304734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182197927 | ||||||||
| FaxNumber: | 7185975242 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 NE 8TH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330304734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182197927 | ||||||||
| FaxNumber: | 7185975242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2013 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN 586 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.