MEDICARE: RANDAL G WORTH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS5801	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	110083302	OTHER		RAILROAD MEDICARE
7	1239864	OTHER		UNITED HEALTHCARE COMMERCIAL AND MEDICARE PLANS
9	80386	OTHER	FL	BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	591273247	OTHER		UHC EMPIRE PLAN
2	80386	OTHER	FL	BLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE, AND TRADITIONAL BCBS
3	602940	OTHER		MAIL HANDLERS BENEFIT PLAN (MHBP)
4	80386	OTHER	FL	OUT OF STATE BLUE CROSS BLUE SHIELD
5	212796	OTHER		AVMED
8	3020563	OTHER		CIGNA PPO/HMO, OPEN ACCESS AND GREATWEST
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023007028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDAL G WORTH DO

Provider Business Mailing Address
First Line	:	13644 WALSINGHAM RD
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-3532
Country	:	US
Telephone Number	:	727-595-2519
Fax Number	:	727-595-3872

Provider Business Practice Location Address
First Line	:	13644 WALSINGHAM RD
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-3532
Country	:	US
Telephone Number	:	727-595-2519
Fax Number	:	727-595-3872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/22/2013

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Directions to “ RANDAL G WORTH DO” Practice Location

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