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General NPI Number Information
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NPI Number | 1649492232
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Entity Type | Organization
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Legal Business Name | MOUNTAINVIEW SKIN CARE PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 4680 BROWNSBORO RD B
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3428
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Country | US
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Telephone | 336-893-8423
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Fax | 336-893-8426
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Provider Business Mailing Address
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Address Line | 127 S POPLAR ST
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3755
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Country | US
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Telephone | 336-893-8423
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Fax | 336-893-8426
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | DR. PAUL WORTMAN
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Credential | M.D.
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Telephone | 336-893-8423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 126743
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License Number State | NC
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