Provider Demographics
NPI:1598795593
Name:WERNER, BARRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHAEL
Last Name:WERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-04-07
Deactivation Date:2021-03-15
Deactivation Code:
Reactivation Date:2021-04-07
Provider Licenses
StateLicense IDTaxonomies
FL30464207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057544500Medicaid
FLD58739Medicare UPIN