Provider Demographics
NPI:1114945631
Name:DPMWERNERNRFL
Entity Type:Organization
Organization Name:DPMWERNERNRFL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-742-4460
Mailing Address - Street 1:3546 ENTERPRISE RD E
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5407
Mailing Address - Country:US
Mailing Address - Phone:727-742-4460
Mailing Address - Fax:
Practice Address - Street 1:12680 95TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1249
Practice Address - Country:US
Practice Address - Phone:727-742-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2826213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT30661Medicare UPIN
FL65638XMedicare ID - Type Unspecified