MEDICARE: CHESTER C. ROBERT WHITLEY IV P.A.-C

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	363A00000X	Physician Assistant	PA1517	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	V72760	OTHER	NV	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA1517	OTHER	NV	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740550078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHESTER C. ROBERT WHITLEY IV P.A.-C

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	725-258-2982
Fax Number	:	407-770-0661

Provider Business Practice Location Address
First Line	:	4517 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7620
Country	:	US
Telephone Number	:	725-258-2982
Fax Number	:	877-709-4341

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

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	02/27/2025

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