MEDICARE: GARY NATHANAEL WORTZ 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	207W00000X	Ophthalmology Physician	40650	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000571982	OTHER	KY	ANTHEM
2	9293157	OTHER	KY	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	40650	OTHER	KY	KY MEDICAL LICENSE
5	0744160	OTHER	KY	CIGNA
6	ME104362	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1710055041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY NATHANAEL WORTZ MD

Provider Business Mailing Address
First Line	:	2353 ALEXANDRIA DR STE 260
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3208
Country	:	US
Telephone Number	:	859-224-2655
Fax Number	:	859-223-7147

Provider Business Practice Location Address
First Line	:	2353 ALEXANDRIA DR STE 260
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3208
Country	:	US
Telephone Number	:	859-224-2655
Fax Number	:	859-223-7147

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/07/2023

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