Provider Demographics
NPI:1407831449
Name:WORTHAM, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6254
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-590-8232
Practice Address - Street 1:2391 NE LOOP 410
Practice Address - Street 2:STE 405
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5600
Practice Address - Country:US
Practice Address - Phone:210-654-7326
Practice Address - Fax:210-590-8232
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1063207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045109801Medicaid
TX390004831OtherMEDICARE RAILROAD
TX86G212Medicare PIN
TXF09303Medicare UPIN