Provider Demographics
NPI:1437315512
Name:WORTSMAN, GARY (LMT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WORTSMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAIRFIELD BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4626
Mailing Address - Country:US
Mailing Address - Phone:904-543-1311
Mailing Address - Fax:904-543-1311
Practice Address - Street 1:2 FAIRFIELD BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4626
Practice Address - Country:US
Practice Address - Phone:904-543-1311
Practice Address - Fax:904-543-1311
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7057OtherBLUE CROSS BLUE SHIELD