Provider Demographics
NPI:1427153386
Name:WORTHAM, ROGER LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93243
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-3243
Mailing Address - Country:US
Mailing Address - Phone:337-565-0200
Mailing Address - Fax:337-565-0200
Practice Address - Street 1:600 JEFFERSON ST STE 909
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6964
Practice Address - Country:US
Practice Address - Phone:337-565-0200
Practice Address - Fax:337-565-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00640662084P0800X
LA0164632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
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