Provider Demographics
NPI:1639279656
Name:WERNER, SANDRA V (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:V
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 1:1019 PACIFIC AVE
Mailing Address - Street 2:STE. 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4443
Mailing Address - Country:US
Mailing Address - Phone:253-597-4550
Mailing Address - Fax:253-597-4556
Practice Address - Street 1:134 188TH ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4618
Practice Address - Country:US
Practice Address - Phone:253-847-2304
Practice Address - Fax:253-847-8857
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25285207Q00000X
WAMD60485823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022664Medicaid
OR022664Medicaid
I08480Medicare UPIN
R119453Medicare PIN