Provider Demographics
NPI:1063557247
Name:WORST, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WORST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RIVER VISTA PL
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3056
Mailing Address - Country:US
Mailing Address - Phone:208-734-0446
Mailing Address - Fax:208-734-1502
Practice Address - Street 1:526 SHOUP AVE W STE M
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5050
Practice Address - Country:US
Practice Address - Phone:208-734-0446
Practice Address - Fax:208-734-1502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM30972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000161800Medicaid
ID33811OtherBLUE CROSS OF IDAHO
ID000010002459OtherREGENCE BLUE SHIELD
B63210Medicare UPIN