Provider Demographics
NPI:1730183765
Name:WHARTON, GEORGE W (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:WHARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1322
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1322
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:972-991-9548
Practice Address - Street 1:1341 W. MOCKINGBIRD LN
Practice Address - Street 2:MOCKINGBIRD TOWERS, SUITE 710E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-217-7520
Practice Address - Fax:214-217-7530
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6344207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX883286OtherBCBS
TX137748301Medicaid
TX137748302Medicaid
TXC23366Medicare UPIN
TX137748301Medicaid
TXP00143258Medicare PIN
TX883286Medicare PIN