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Individual

CHESTER C. ROBERT WHITLEY IV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.-C

Contact information

Practice address
4517 BLUE DIAMOND RD, LAS VEGAS, NV 89139-7620
(725) 258-2982
(877) 709-4341
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(725) 258-2982
(407) 770-0661

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1517
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1740550078
NV
01
PA1517
STATE LICENSE
NV
01
V72760
MEDICARE
NV
Enumeration date
01/03/2012
Last updated
02/12/2026
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