Provider Demographics
NPI:1275569220
Name:WERTH, DARRELL D (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:D
Last Name:WERTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1176
Mailing Address - Country:US
Mailing Address - Phone:785-628-6014
Mailing Address - Fax:785-628-6094
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 308
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-628-6014
Practice Address - Fax:785-628-6094
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416899208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS002343Medicare ID - Type Unspecified
KSD05265Medicare UPIN