Provider Demographics
NPI:1588621908
Name:WHARTON, ROBERT H JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:WHARTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:4855 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8107
Practice Address - Country:US
Practice Address - Phone:727-321-6450
Practice Address - Fax:727-327-2668
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24918207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037655800Medicaid
410013097OtherRAILROAD MCR
FL55065OtherBCBS
FL037655800Medicaid
410013097OtherRAILROAD MCR