Provider Demographics
NPI:1528096542
Name:WHARTON, ARNOLD D (MD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:D
Last Name:WHARTON
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 1:900 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2129
Mailing Address - Country:US
Mailing Address - Phone:903-595-2626
Mailing Address - Fax:903-592-5212
Practice Address - Street 1:900 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2129
Practice Address - Country:US
Practice Address - Phone:903-595-2626
Practice Address - Fax:903-592-5212
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000F9172Medicaid
00F917Medicare ID - Type Unspecified
B27527Medicare UPIN