=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982836276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER PAUL WERNER DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2009
-----------------------------------------------------
Last Update Date | 03/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 OLD HIGHWAY 1187
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-0281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-926-2663
-----------------------------------------------------
Fax | 817-293-8860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 OLD HIGHWAY 1187
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-0281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-926-2663
-----------------------------------------------------
Fax | 817-293-8860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 2007
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------