Provider Demographics
NPI:1578547873
Name:WERNER, CARMEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MARIE
Last Name:WERNER
Suffix:
Gender:F
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 51570
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1570
Mailing Address - Country:US
Mailing Address - Phone:806-468-4375
Mailing Address - Fax:806-468-4359
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:SUITE 2001
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-468-4350
Practice Address - Fax:806-468-4351
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124605005Medicaid
TXG20473Medicare UPIN
TX8B2683Medicare ID - Type Unspecified