Provider Demographics
NPI:1114984564
Name:WORSLEY, J. BEN (MD)
Entity Type:Individual
Prefix:
First Name:J. BEN
Middle Name:
Last Name:WORSLEY
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:6401 HARRIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6101
Practice Address - Country:US
Practice Address - Phone:817-346-2525
Practice Address - Fax:817-294-1692
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK05742080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121406603Medicaid
TX121406606Medicaid
TX83213XOtherBCBS
TX10024641OtherAMERIGROUP
TX5844625OtherAETNA
TX130900705OtherMEDICAID EPSDT
TX83213XOtherBCBS
TX130900705OtherMEDICAID EPSDT