Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME61450 | FL |
NPI | 1003896390 |
---|---|
Provider Name | Mark Henry Werner |
First Address | Gainesville, FL 32605-4582 |
Second Address | Gainesville, FL 32607-2817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F09662 | (02) | FL |