Provider Demographics
NPI:1720735475
Name:WERNER, JOHN LESTER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LESTER
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 1:1495 SEAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6580
Mailing Address - Country:US
Mailing Address - Phone:562-430-9555
Mailing Address - Fax:
Practice Address - Street 1:1495 SEAL WAY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6580
Practice Address - Country:US
Practice Address - Phone:562-430-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG134372085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty