Healthcare Provider Details

I. General information

NPI: 1023014453
Provider Name (Legal Business Name): DELWYN J WORTHINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N 44TH ST STE 100
PHOENIX AZ
85018-7227
US

IV. Provider business mailing address

PO BOX 80217
PHOENIX AZ
85060-0217
US

V. Phone/Fax

Practice location:
  • Phone: 602-631-3161
  • Fax: 602-631-3162
Mailing address:
  • Phone: 602-385-2115
  • Fax: 602-772-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17690
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: