Provider Demographics
NPI:1629096458
Name:WERTHER, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:WERTHER
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:PO BOX 16455
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-6455
Mailing Address - Country:US
Mailing Address - Phone:480-615-2010
Mailing Address - Fax:480-545-4158
Practice Address - Street 1:1220 S HIGLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4001
Practice Address - Country:US
Practice Address - Phone:480-827-5045
Practice Address - Fax:480-827-5181
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4235002OtherAETNA
AZ956196Medicaid
AZ2Z5140OtherHEALTH NET
AZ956196002OtherMERCY CARE
AZAZ0153391OtherBLUE CROSS BLUE SHIELD
A64398Medicare UPIN