Healthcare Provider Details

I. General information

NPI: 1457561086
Provider Name (Legal Business Name): KURT ANDREW WHARTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KURT ANDREW WHARTON M.D.

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 N ZANJERO BLVD PALO VERDE CANCER CENTER-WEST VALLEY
GLENDALE AZ
85308
US

IV. Provider business mailing address

4611 E. SHEA BLVD STE 120
PHOENIX AZ
85028-4254
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-3845
  • Fax: 602-464-9769
Mailing address:
  • Phone: 602-441-3845
  • Fax: 602-464-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number43287
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: