Healthcare Provider Details

I. General information

NPI: 1174790042
Provider Name (Legal Business Name): JAMES DOTSE WORNYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 6250
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE 6250
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8394
  • Fax: 937-208-8388
Mailing address:
  • Phone: 937-208-8394
  • Fax: 937-208-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.120108
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC1-0027057
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13880
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.120108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: