Provider Demographics
NPI:1699845123
Name:WORTHEN, GEORGE SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:SCOTT
Last Name:WORTHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G
Other - Middle Name:SCOTT
Other - Last Name:WORTHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MF
Mailing Address - Street 1:1400 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2761
Mailing Address - Country:US
Mailing Address - Phone:303-388-4461
Mailing Address - Fax:303-270-2174
Practice Address - Street 1:1400 JACKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2761
Practice Address - Country:US
Practice Address - Phone:303-388-4461
Practice Address - Fax:303-270-2174
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01262898Medicaid
COJ6524Medicare ID - Type UnspecifiedNORIDIAN
CO01262898Medicaid