Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD-20570 | HI |
Y | 111NI0900X | Internist | MD-20570 | HI |
NPI | 1003264417 |
---|---|
Provider Name | Mr. Adrian Scott Worthen |
First Address | Tripler Army Medical Center, HI 96859-5001 |
Second Address | Tripler Army Medical Center, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 21/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | HI |