Basic Information
| Provider Information | |||||||||
| NPI: | 1427158062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERDER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667622546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
| FaxNumber: | 6202312808 | ||||||||
| Practice Location | |||||||||
| Address1: | 2990 MILITARY AVE | ||||||||
| Address2: | |||||||||
| City: | BAXTER SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667132331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208562900 | ||||||||
| FaxNumber: | 6208562901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 05-23061 | KS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207R00000X | 05-23061 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100332790C | 05 | KS | MEDICAID |