Provider Demographics
NPI:1962950188
Name:WHALL, ANTHONY T (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
Last Name:WHALL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:786-235-6225
Practice Address - Street 1:10301 HAGEN RANCH RD STE B6
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3723
Practice Address - Country:US
Practice Address - Phone:561-752-9490
Practice Address - Fax:561-752-9491
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2018-03-02
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9109798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant