Provider Demographics
NPI:1356326805
Name:WORDEN, WILLIAM LAMONT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAMONT
Last Name:WORDEN
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 1:5916 S SADDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-7713
Mailing Address - Country:US
Mailing Address - Phone:509-927-7528
Mailing Address - Fax:
Practice Address - Street 1:6640 KANIKSU ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7532
Practice Address - Country:US
Practice Address - Phone:208-267-3141
Practice Address - Fax:208-267-2202
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0023441207P00000X
IDM8025207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1040948Medicaid
IDCS8620OtherBOARD OF PHARMACY
BW0443503OtherDEA
WA1040948Medicaid
IDCS8620OtherBOARD OF PHARMACY