Provider Demographics
NPI:1316970031
Name:WORKMAN, THEODORE E JR (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:E
Last Name:WORKMAN
Suffix:JR
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:PO BOX 990279
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0279
Mailing Address - Country:US
Mailing Address - Phone:530-241-5499
Mailing Address - Fax:530-241-5677
Practice Address - Street 1:2111 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-247-3733
Practice Address - Fax:530-247-6906
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65834207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G658340Medicaid
CA680449587OtherBLUE CROSS
CA00G658341Medicare ID - Type Unspecified