MEDICARE: DR. CARMEN MARIE WERNER M.D.

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	208000000X	Pediatrics Physician	K1129	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	:	1578547873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN MARIE WERNER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 51570
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79159-1570
Country	:	US
Telephone Number	:	806-468-4375
Fax Number	:	806-468-4359

Provider Business Practice Location Address
First Line	:	1901 MEDI PARK DR
Second Line	:	SUITE 2001
City	:	AMARILLO
State	:	TX
Zip	:	79106-2110
Country	:	US
Telephone Number	:	806-468-4350
Fax Number	:	806-468-4351

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	04/09/2010

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