Healthcare Provider Details

I. General information

NPI: 1023009966
Provider Name (Legal Business Name): ANDREAS H WERLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 BAYSHORE RD STE 110
PORT CHARLOTTE FL
33980-2005
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-4900
  • Fax: 941-235-4901
Mailing address:
  • Phone: 239-343-6050
  • Fax: 239-343-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9010
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number42792
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME121693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: