Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0006485 | MO |
NPI | 1205922283 |
---|---|
Provider Name | Dr. Matthew Worth |
First Address | Fenton, MO 63026-0672 |
Second Address | Valley Park, MO 63088-2097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110148 | BCBS (01) | MO |
293524 | HEALTHLINK (01) | MO |
U62078 | (02) | MO |