Basic Information
| Provider Information | |||||||||
| NPI: | 1356430565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORSHAM | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 E ANN ARBOR AVE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752166718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143761701 | ||||||||
| FaxNumber: | 9722171161 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 FULLER DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728705511 | ||||||||
| FaxNumber: | 9728705512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H3617 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8U3448 | 01 | TX | BCBS OF TEXAS | OTHER | 123032805 | 05 | TX | MEDICAID | P00279109 | 01 | TX | RR MEDICARE | OTHER |