Healthcare Provider Details

I. General information

NPI: 1407831449
Provider Name (Legal Business Name): WILLIAM WORTHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 NE LOOP 410 STE 405
SAN ANTONIO TX
78217-5600
US

IV. Provider business mailing address

7142 SAN PEDRO AVE SUITE 120
SAN ANTONIO TX
78216-6254
US

V. Phone/Fax

Practice location:
  • Phone: 210-654-7326
  • Fax: 210-590-8232
Mailing address:
  • Phone: 210-661-5622
  • Fax: 210-590-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberJ1063
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: