Healthcare Provider Details

I. General information

NPI: 1578569539
Provider Name (Legal Business Name): RICHARD S WERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE. S SUITE 276
EDINA MN
55435
US

IV. Provider business mailing address

7801 EAST BUSH LAKE RD SUITE 320
BLOOMINGTON MN
55439
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-1812
  • Fax: 952-929-1943
Mailing address:
  • Phone: 952-831-5773
  • Fax: 952-831-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25128
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: