Provider Demographics
NPI:1023007028
Name:WORTH, RANDAL G (DO)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:G
Last Name:WORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:13644 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3532
Mailing Address - Country:US
Mailing Address - Phone:727-595-2519
Mailing Address - Fax:727-595-3872
Practice Address - Street 1:13644 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3532
Practice Address - Country:US
Practice Address - Phone:727-595-2519
Practice Address - Fax:727-595-3872
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
591273247OtherUHC EMPIRE PLAN
FL80386OtherBLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE, AND TRADITIONAL BCBS
602940OtherMAIL HANDLERS BENEFIT PLAN (MHBP)
FL80386OtherOUT OF STATE BLUE CROSS BLUE SHIELD
212796OtherAVMED
110083302OtherRAILROAD MEDICARE
1239864OtherUNITED HEALTHCARE COMMERCIAL AND MEDICARE PLANS
3020563OtherCIGNA PPO/HMO, OPEN ACCESS AND GREATWEST
FL80386OtherBCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE
FL063927300Medicaid
FL80386OtherBLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE, AND TRADITIONAL BCBS
602940OtherMAIL HANDLERS BENEFIT PLAN (MHBP)