Donald Gene Wortham, MD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

MD00020164 Issued in WA

Practice address

19109 36TH Ave W
Suite 109
Lynnwood, WA 98036-5767

Phone

(425) 744-7771

Fax

(425) 744-7774

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1164504197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19109 36TH AVE W",
            "address_2": "SUITE 109",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365767",
            "telephone_number": "425-744-7771",
            "fax_number": "425-744-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19109 36TH AVE W",
            "address_2": "SUITE 109",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365767",
            "telephone_number": "425-744-7771",
            "fax_number": "425-744-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORTHAM",
        "first_name": "DONALD",
        "middle_name": "GENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "MD00020164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WO009",
            "identifier": "REGENCE",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "107361",
            "identifier": "LABOR & INDUSTRY",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Woodway Chiropractic Massage and Rehabilitation PS
• Tina Marie Wooley
• Joanne Woolfenden, P.T.
• Brandon Michael Woolley
• Frederick Worrell, DDS
• Dantley Thomas Wright
• Patrick William Wright, DO
• Cindy Yi-Jen Wu, L.AC.
• Emily Jiaying Wu
• Grace Wenchen Hsiao Wu, DMD

• Ambulatory Surgical Clinic/Center in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.