MEDICARE: DR. RUBY REXENE WORRELL MD

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	207ZF0201X	Forensic Pathology Physician	9890	NV

General Provider Information

NPI Number	:	1457720708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBY REXENE WORRELL MD

Provider Business Mailing Address
First Line	:	1225 LOS MEADOWS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1903
Country	:	US
Telephone Number	:	702-682-7777
Fax Number	:	702-543-4013

Provider Business Practice Location Address
First Line	:	1225 LOS MEADOWS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1903
Country	:	US
Telephone Number	:	702-682-7777
Fax Number	:	702-543-4013

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

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	11/30/2025

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