MEDICARE: ROBIN L. WORSHAM MD

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	207Q00000X	Family Medicine Physician	H3617	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00279109	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8U3448	OTHER	TX	BCBS OF TEXAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356430565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN L. WORSHAM MD

Provider Business Mailing Address
First Line	:	550 E ANN ARBOR AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-6718
Country	:	US
Telephone Number	:	214-376-1701
Fax Number	:	972-217-1161

Provider Business Practice Location Address
First Line	:	4545 FULLER DR
Second Line	:	SUITE 340
City	:	IRVING
State	:	TX
Zip	:	75038-6530
Country	:	US
Telephone Number	:	972-870-5511
Fax Number	:	972-870-5512

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/28/2011

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Directions to “ ROBIN L. WORSHAM MD” Practice Location

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