Healthcare Provider Details

I. General information

NPI: 1518589209
Provider Name (Legal Business Name): CASON JAMES WORTLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 N 400 E STE 202
LOGAN UT
84341-1891
US

IV. Provider business mailing address

759 CHESTNUT ST
SPRINGFIELD MA
01199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-7337
  • Fax:
Mailing address:
  • Phone: 413-794-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13459389-1204
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: