Provider Demographics
NPI:1477789931
Name:WORLEY, TODD A (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:WORLEY
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 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:713-441-5151
Mailing Address - Fax:
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:713-441-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3393208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477789931OtherBLUE CROSS BLUE SHIELD
TX203112202Medicaid
TX203112204Medicaid
TX8CL160OtherBCBS
TX203112203Medicaid
TXTXB145716Medicare PIN
TX1477789931OtherBLUE CROSS BLUE SHIELD
TX538015ZSWDMedicare PIN