MEDICARE: LATHON DOYLE WORTHINGTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	K5244	TX

General Provider Information

NPI Number	:	1235196502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATHON DOYLE WORTHINGTON M.D.

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 BURNET RD
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-8520
Country	:	US
Telephone Number	:	325-348-3944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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