Provider Demographics
NPI:1518024108
Name:WERNER, DARRYL JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:JONATHAN
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 1:951 HERON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:949-351-8977
Mailing Address - Fax:562-430-6706
Practice Address - Street 1:951 HERON CIRCLE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:949-351-8977
Practice Address - Fax:562-430-6706
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG066730208D00000X
CAG66730207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G66730Medicaid
E92393Medicare UPIN
CAWG66730RMedicare UPIN