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NPI Code Detail

MEDICARE: GARY WORTSMAN LMT

MEDICARE:   GARY  WORTSMAN  LMT
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
1175F00000XNaturopath

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C7057OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1437315512
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY WORTSMAN LMT
Provider Business Mailing Address
First Line : 2 FAIRFIELD BLVD
Second Line : SUITE 5
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-4626
Country : US
Telephone Number : 904-543-1311
Fax Number : 904-543-1311
Provider Business Practice Location Address
First Line : 2 FAIRFIELD BLVD
Second Line : SUITE 5
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-4626
Country : US
Telephone Number : 904-543-1311
Fax Number : 904-543-1311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2008
Last Update Date : 07/29/2008

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