Provider Demographics
NPI:1073879821
Name:WORTHEN, TUCKER (DPM)
Entity Type:Individual
Prefix:DR
First Name:TUCKER
Middle Name:
Last Name:WORTHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 WILMINGTON DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6103
Mailing Address - Country:US
Mailing Address - Phone:970-416-9009
Mailing Address - Fax:
Practice Address - Street 1:1927 WILMINGTON DR UNIT 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6103
Practice Address - Country:US
Practice Address - Phone:970-416-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000771213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29770050Medicaid