Provider Demographics
NPI:1457561086
Name:WHARTON, KURT ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:ANDREW
Last Name:WHARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KURT
Other - Middle Name:ANDREW
Other - Last Name:WHARTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4611 E. SHEA BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4254
Mailing Address - Country:US
Mailing Address - Phone:602-441-3845
Mailing Address - Fax:602-464-9769
Practice Address - Street 1:7410 N ZANJERO BLVD
Practice Address - Street 2:PALO VERDE CANCER CENTER-WEST VALLEY
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-441-3845
Practice Address - Fax:602-464-9769
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ432872085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ537308Medicaid