Provider Demographics
NPI:1417021130
Name:WERTH, JAMES LAREE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LAREE
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 1:5118 PALM VALLEY DR S
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-9061
Mailing Address - Country:US
Mailing Address - Phone:956-454-9516
Mailing Address - Fax:956-412-6661
Practice Address - Street 1:5118 PALM VALLEY DR S
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-9061
Practice Address - Country:US
Practice Address - Phone:956-454-9516
Practice Address - Fax:956-412-6661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX J1810207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB67678Medicare UPIN