Provider Demographics
NPI:1356430565
Name:WORSHAM, ROBIN L (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:WORSHAM
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 1:550 E ANN ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-6718
Mailing Address - Country:US
Mailing Address - Phone:214-376-1701
Mailing Address - Fax:972-217-1161
Practice Address - Street 1:4545 FULLER DR
Practice Address - Street 2:SUITE 340
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6530
Practice Address - Country:US
Practice Address - Phone:972-870-5511
Practice Address - Fax:972-870-5512
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U3448OtherBCBS OF TEXAS
TX123032805Medicaid
TXP00279109OtherRR MEDICARE
TX123032805Medicaid