Provider Demographics
NPI:1679504047
Name:WADHERA, ASHOK KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:KUMAR
Last Name:WADHERA
Suffix:
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 1:304 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4506
Mailing Address - Country:US
Mailing Address - Phone:850-785-1700
Mailing Address - Fax:850-785-1759
Practice Address - Street 1:304 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4506
Practice Address - Country:US
Practice Address - Phone:850-785-1700
Practice Address - Fax:850-785-1759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG82009Medicare UPIN
FL71112BMedicare ID - Type Unspecified