MEDICARE: JUDITH KAY WERNER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H2898	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467454355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH KAY WERNER D.O.

Provider Business Mailing Address
First Line	:	2800 E. BROAD ST.
Second Line	:	SUITE 508
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6417
Country	:	US
Telephone Number	:	817-473-8791
Fax Number	:	817-473-7639

Provider Business Practice Location Address
First Line	:	2800 E. BROAD ST.
Second Line	:	SUITE 508
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6417
Country	:	US
Telephone Number	:	817-473-8791
Fax Number	:	817-473-7639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	06/23/2010

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