Basic Information
| Provider Information | |||||||||
| NPI: | 1194873943 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GLENN L. WERNER, M.D. PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1264 RIBAUT RD | ||||||||
| Address2: | BUILDING 200 | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299026123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435245455 | ||||||||
| FaxNumber: | 8435245655 | ||||||||
| Practice Location | |||||||||
| Address1: | 1264 RIBAUT RD | ||||||||
| Address2: | BUILDING 200 | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299026123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435245455 | ||||||||
| FaxNumber: | 8435245655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WERNER | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8435245455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 15977 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.