Healthcare Provider Details

I. General information

NPI: 1508211517
Provider Name (Legal Business Name): ERIC MATTHEW WHERLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 320
TAMPA FL
33613-4681
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 320
TAMPA FL
33613-4681
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-0027
  • Fax: 813-971-1286
Mailing address:
  • Phone: 813-910-0027
  • Fax: 813-971-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME150189
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME150189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: