Provider Demographics
NPI:1831515147
Name:WERNER, MARTIN (INDEPENDANT DUTY COR)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:WERNER
Suffix:
Gender:M
Credentials:INDEPENDANT DUTY COR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 BINZ ENGLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-2219
Mailing Address - Country:US
Mailing Address - Phone:210-223-1551
Mailing Address - Fax:210-271-3826
Practice Address - Street 1:3837 BINZ ENGLEMAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-2219
Practice Address - Country:US
Practice Address - Phone:210-223-1551
Practice Address - Fax:210-271-3826
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman