DR. DONALD GENE WORTHAM MD NPI 1164504197

NPI Information

  • NPI: 1164504197
  • Provider Name: DR. DONALD GENE WORTHAM, MD
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 19109 36TH AVE W
    SUITE 109
    LYNNWOOD, WA
    ZIP 98036
  • Phone: (425) 744-7771

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NPI Details

DR. Donald Gene Wortham, MD is an ambulatory surgical clinic center in Lynnwood, WA. DR. Donald Gene Wortham, MD NPI is 1164504197. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

19109 36TH AVE W
SUITE 109
LYNNWOOD, WA
ZIP 98036-767
Phone: (425) 744-7771
Fax: (425) 744-7774

The NPI 1164504197 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 10/19/2006 and was last updated on 1/22/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory SurgicalMD00020164WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1LABOR & INDUSTRYOTHERWASHINGTON107361
2AB10710MEDICARE ID-TYPE UNSPECIFIEDWASHINGTON
3REGENCEOTHERWASHINGTONWO009
4E72553MEDICARE UPINWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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