Provider Demographics
NPI:1578569539
Name:WERNER, RICHARD S (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:WERNER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7801 EAST BUSH LAKE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:952-831-5773
Mailing Address - Fax:952-831-7224
Practice Address - Street 1:6545 FRANCE AVE. S
Practice Address - Street 2:SUITE 276
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-929-1812
Practice Address - Fax:952-929-1943
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2009-07-14
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Provider Licenses
StateLicense IDTaxonomies
MN251282086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800795100Medicaid
MN800795100Medicaid
A94079Medicare UPIN