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General NPI Number Information
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NPI Number | 1710055041
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Entity Type | Individual
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Provider Name | GARY NATHANAEL WORTZ MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2353 ALEXANDRIA DR STE 260
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City | LEXINGTON
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State | KY
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Zip | 40504-3208
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Country | US
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Telephone | 859-224-2655
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Fax | 859-223-7147
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Provider Business Mailing Address
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Address Line | 2353 ALEXANDRIA DR STE 260
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City | LEXINGTON
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State | KY
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Zip | 40504-3208
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Country | US
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Telephone | 859-224-2655
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Fax | 859-223-7147
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 40650
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License Number State | KY
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