Provider Demographics
NPI:1750326526
Name:THOMAS G. WERNER, D.P.M., P.A.
Entity Type:Organization
Organization Name:THOMAS G. WERNER, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:479-968-1311
Mailing Address - Street 1:2503 W MAIN PL
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4645
Mailing Address - Country:US
Mailing Address - Phone:479-968-1311
Mailing Address - Fax:479-968-2704
Practice Address - Street 1:2503 W MAIN PL
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4645
Practice Address - Country:US
Practice Address - Phone:479-968-1311
Practice Address - Fax:479-968-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4736750001Medicare NSC
AR5C146Medicare PIN