MEDICARE: CHARLES HOWARD WHEATON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY2942	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00407182	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730157801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HOWARD WHEATON PHD

Provider Business Mailing Address
First Line	:	2240 BELLEAIR RD
Second Line	:	SUITE 170
City	:	CLEARWATER
State	:	FL
Zip	:	33764-1706
Country	:	US
Telephone Number	:	727-535-0468
Fax Number	:	727-535-2588

Provider Business Practice Location Address
First Line	:	2240 BELLEAIR RD
Second Line	:	SUITE 170
City	:	CLEARWATER
State	:	FL
Zip	:	33764-1706
Country	:	US
Telephone Number	:	727-535-0468
Fax Number	:	727-535-2588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/09/2008

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