Provider Demographics
NPI:1699703066
Name:WORRICH, SCOTT P (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:WORRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 NE LOOP 410 STE 850
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5824
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-805-8770
Practice Address - Street 1:4680 LOCKHILL SELMA RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2094
Practice Address - Country:US
Practice Address - Phone:210-546-1480
Practice Address - Fax:210-546-1489
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT179497208VP0000X
TXM4663208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1843138-03Medicaid
TX134313803Medicaid
TX8J3000Medicare PIN