Individual
ETHAN B WORTHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
805 HALL ST, WIGGINS, MS 39577-2110
(601) 928-4412
(601) 928-4792
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 928-4412
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21272
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06001526
—
MS
01
—
6041733
HEALTHSPRING
MS
01
—
9912622
AETNA
MS
01
—
P00896972
RAILROAD MEDICARE
MS
Enumeration date
09/11/2007
Last updated
08/23/2016
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