Provider Demographics
NPI:1558360180
Name:WORTHINGTON, JUNE B (DO)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:B
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25647 REDWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9332
Mailing Address - Country:US
Mailing Address - Phone:541-592-6444
Mailing Address - Fax:
Practice Address - Street 1:25647 REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9332
Practice Address - Country:US
Practice Address - Phone:541-592-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080544Medicaid
NMNM004B96OtherBCBS
NM12651249Medicaid
ORDO19805OtherSTATE LICENSE ID
ORDO19805OtherSTATE LICENSE ID
OR080544Medicaid
NM344524208Medicare PIN