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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 |
