Provider Demographics
NPI:1467454355
Name:WERNER, JUDITH KAY (DO)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:KAY
Last Name:WERNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E. BROAD ST.
Mailing Address - Street 2:SUITE 508
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6417
Mailing Address - Country:US
Mailing Address - Phone:817-473-8791
Mailing Address - Fax:817-473-7639
Practice Address - Street 1:2800 E. BROAD ST.
Practice Address - Street 2:SUITE 508
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6417
Practice Address - Country:US
Practice Address - Phone:817-473-8791
Practice Address - Fax:817-473-7639
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127982-004Medicaid
TX00D69ZMedicare ID - Type Unspecified
TXA67781Medicare UPIN