Healthcare Provider Details

I. General information

NPI: 1922095777
Provider Name (Legal Business Name): STEPHEN FORDYCE WORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 W ALASKA DR STE 250
LAKEWOOD CO
80226-3327
US

IV. Provider business mailing address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

V. Phone/Fax

Practice location:
  • Phone: 303-592-7284
  • Fax: 303-892-0601
Mailing address:
  • Phone: 303-592-7284
  • Fax: 303-892-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number40347
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: