Provider Demographics
NPI:1417984709
Name:BARRY M. WERNER, M.D., P.A.
Entity Type:Organization
Organization Name:BARRY M. WERNER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-722-2000
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-722-2000
Mailing Address - Fax:954-722-2466
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 305
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-722-2000
Practice Address - Fax:954-722-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2021-04-07
Deactivation Date:2021-03-15
Deactivation Code:
Reactivation Date:2021-04-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057544500Medicaid
FL79312Medicare PIN