MEDICARE: DR. J TRACE 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	H6717	TX

General Provider Information

NPI Number	:	1790765816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J TRACE WORRELL MD

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD
Second Line	:	SUITE 400
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	800 W RANDOL MILL RD FL 3
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2504
Country	:	US
Telephone Number	:	817-960-6225
Fax Number	:	817-960-6519

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	09/26/2017

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