Provider Demographics
NPI:1396064036
Name:WORTHAM, WEBSTER LEE
Entity type:Individual
Prefix:MR
First Name:WEBSTER
Middle Name:LEE
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 E KING ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-6832
Mailing Address - Country:US
Mailing Address - Phone:918-619-5104
Mailing Address - Fax:
Practice Address - Street 1:6816 E KING ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-6832
Practice Address - Country:US
Practice Address - Phone:918-619-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator