Basic Information
Provider Information
NPI: 1053593830
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WORDEN
FirstName: WILLIAM
MiddleName: LAMONT
NamePrefix:  
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3333 BURNET AVE
Address2: ANESTHESIA, ML 2001
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364408
FaxNumber: 5136367337
Practice Location
Address1: 3333 BURNET AVE
Address2: ANESTHESIA, ML 2001
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364408
FaxNumber: 5136367337
Other Information
ProviderEnumerationDate: 12/03/2007
LastUpdateDate: 08/09/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LP3000X35.097621OHY Allopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology

No ID Information.


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