Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 23370 | WI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 23370 | WI |
NPI | 1245224864 |
---|---|
Provider Name | Dennis Worthington |
First Address | Wauwatosa, WI 53226-4216 |
Second Address | Wauwatosa, WI 53226-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 06/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245224864 | (05) | WI |
30340800 | (05) | WI |
B57741 | (02) |