Provider Demographics
NPI:1912995671
Name:WERNER, LINDA J (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:WERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JANET
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2949
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2949
Mailing Address - Country:US
Mailing Address - Phone:907-262-3119
Mailing Address - Fax:907-262-9290
Practice Address - Street 1:230 E MARYDALE AVE STE 1
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-262-3119
Practice Address - Fax:907-262-9290
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071662207R00000X
WI29529-020207R00000X
AK6597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK164556OtherMEDICARE PTAN
CA389588041OtherTRICARE
AKMD9296Medicaid
WIP00168644OtherRR-MEDICARE
WI31530100Medicaid
AKK0000WCVBSOtherMEDICARE PRACTICE PTAN PENINSULA INTERNAL MEDICINE
WI389588041900OtherBCBS
CA389588041OtherTRICARE
AKK0000WCVBSOtherMEDICARE PRACTICE PTAN PENINSULA INTERNAL MEDICINE