Provider Demographics
NPI:1831291020
Name:WORTH, BERNARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:WORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:245 RUTH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4323
Mailing Address - Country:US
Mailing Address - Phone:651-735-0501
Mailing Address - Fax:651-735-1870
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-251-8050
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23859207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN20366WOOtherBCBS
MN20366WOOtherBCBS