Provider Demographics
NPI:1467411553
Name:WERT, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:WERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:761 GIPSON LN
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324-4055
Mailing Address - Country:US
Mailing Address - Phone:931-361-1411
Mailing Address - Fax:931-915-1211
Practice Address - Street 1:1260 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2303
Practice Address - Country:US
Practice Address - Phone:931-598-5691
Practice Address - Fax:931-915-1211
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27013202C00000X, 207PE0004X, 207PE0005X, 207QA0401X
AL17203207P00000X, 207QA0401X, 2083X0100X, 208D00000X
OH35.066112207P00000X, 2083P0500X
TNMD00000271032083P0500X, 208D00000X
OH36.066112208D00000X
IL036-101546208D00000X
TNMD0000027013207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00489Medicare UPIN