Provider Demographics
NPI:1265678551
Name:MICHAELSWERNERDPMPA
Entity Type:Organization
Organization Name:MICHAELSWERNERDPMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-328-1111
Mailing Address - Street 1:5704 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4835
Mailing Address - Country:US
Mailing Address - Phone:727-328-1111
Mailing Address - Fax:727-328-1219
Practice Address - Street 1:5704 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4835
Practice Address - Country:US
Practice Address - Phone:727-328-1111
Practice Address - Fax:727-328-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2826213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty