Provider Demographics
NPI:1548268949
Name:WORTH, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:WORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039684207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91084721531OtherKPS
WA8278376Medicaid
WA8934191OtherVICTIMS OF CRIME
WA0150078OtherLABOR AND INDUSTRIES
WA1215WOOtherREGENCE BLUE SHIELD
WA910847215OtherUNIFORM MEDICAL
WAA030OtherTRIWEST
WA016487001OtherGROUP HEALTH CORP
WA050080994OtherRAILROAD MEDICARE
WA910847215OtherPREMERA BLUE CROSS
WA910847215OtherPREMERA BLUE CROSS
WAH38954Medicare UPIN