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Dr. Paul Douglass Wortman

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NPI Number Detailed Information

Provider Information:

Name: Dr. Paul Douglass Wortman
Gender: M
Provider License Number If Given: 35791

NPI Information:

NPI: 1932108461
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/24/2019

Provider Business Mailing Address:

Address: 127 S POPLAR ST
Winston Salem, NC 27101
Phone Number: 3368938423
Fax Number: 3368938426

Provider Business Practice Location Address:

Address: 127 S POPLAR ST
Winston Salem, NC 27101
Phone Number: 3368938423
Fax Number: 3368938426

Provider Taxonomy:

Primary: 207N00000X
Secondary (if any):
State: NC

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