Provider Demographics
NPI:1003859141
Name:WERNER, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:WERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1811 E BERT KOUNS STE 430
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5741
Mailing Address - Country:US
Mailing Address - Phone:318-424-8373
Mailing Address - Fax:318-424-6477
Practice Address - Street 1:1811 E BERT KOUNS STE 430
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-424-8373
Practice Address - Fax:318-424-6477
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA14928R208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158097Medicaid
TX158986301Medicaid
TX1589863Medicaid
4F156Medicare ID - Type Unspecified