Individual
SHANE ROBERT WORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8375
(270) 798-8630
Mailing address
650 JOEL DRIVE, PODIATRY/ORTHO DEPT, FORT CAMPBELL, KY 42223-5318
(270) 798-8325
(270) 798-8630
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
285
NE
Other
Enumeration date
01/30/2008
Last updated
02/04/2019
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