Provider Demographics
NPI:1386614097
Name:WORNOCK, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:WORNOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JP
Other - Middle Name:
Other - Last Name:WORNOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7800
Mailing Address - Country:US
Mailing Address - Phone:501-279-9000
Mailing Address - Fax:501-279-9011
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7800
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130020001Medicaid
ARG33376Medicare UPIN
AR5K214Medicare ID - Type UnspecifiedMEDICARE/BCBS NUMBER