Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2002031477 | MO |
Y | 2080P0203X | Pediatric Critical Care Doctor | 2002031477 | MO |
NPI | 1194990556 |
---|---|
Provider Name | Jason A Werner |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 12/01/2021 |