Provider Demographics
NPI:1750303699
Name:WORTMAN, IVAN JARED (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:JARED
Last Name:WORTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6129 LINNEAL BEACH DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7807
Mailing Address - Country:US
Mailing Address - Phone:407-299-2055
Mailing Address - Fax:407-299-2055
Practice Address - Street 1:7848 W IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1729
Practice Address - Country:US
Practice Address - Phone:407-397-7032
Practice Address - Fax:407-397-7041
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0063259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine