Healthcare Provider Details

I. General information

NPI: 1831298637
Provider Name (Legal Business Name): CARL JOSEPH WERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD EMERGENCY DEPT
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

5780 LILAC TRAILS DRIVE
SAINT LOUIS MO
63128
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1000
  • Fax: 314-525-4868
Mailing address:
  • Phone: 314-487-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR8F40
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: