Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 204 | AL |
Y | 222Z00000X | Podiatrist | 204 | AL |
NPI | 1063484004 |
---|---|
Provider Name | Benjamin J. Werner |
First Address | Dothan, AL 36302-0729 |
Second Address | Dothan, AL 36301-4754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 20/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009995495 | (05) | AL |
121545 | (05) | AL |
511-09066 | BCBS OF AL - HEALTHWEST (01) | AL |
515-27019 | BCBS OF AL 1500 RCC (01) | AL |
810610880A | (05) | GA |
810610880E | (05) | GA |
U73317 | (02) | AL |