Provider Demographics
NPI:1336141696
Name:WORTHEN, RODNEY L II (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:L
Last Name:WORTHEN
Suffix:II
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 1:615 E. OKLAHOMA AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5952
Mailing Address - Country:US
Mailing Address - Phone:580-233-3230
Mailing Address - Fax:580-233-0698
Practice Address - Street 1:615 E. OKLAHOMA AVE.
Practice Address - Street 2:STE 202
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5952
Practice Address - Country:US
Practice Address - Phone:580-233-3230
Practice Address - Fax:580-233-0698
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13665208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10118210AMedicaid
OK340017066OtherRAILROAD MEDICARE
OK100118210AMedicaid
OK$$$$$$$$$PMedicare PIN
OK35429Medicare UPIN
OKD35428Medicare UPIN