Provider Demographics
NPI:1649294133
Name:WORSHAM, STEPHEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
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 1:1115 LOS PALOS DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3853
Mailing Address - Country:US
Mailing Address - Phone:831-758-3851
Mailing Address - Fax:831-758-8701
Practice Address - Street 1:1115 LOS PALOS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3853
Practice Address - Country:US
Practice Address - Phone:831-758-3851
Practice Address - Fax:831-758-8701
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49792208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497920Medicaid
340005100OtherRAILROAD MEDICARE
00A497922OtherMEDICARE PTAN
CA00A497920Medicaid