Provider Demographics
NPI:1174561369
Name:WERNER, JAN REINERT JR (MD)
Entity type:Individual
Prefix:MR
First Name:JAN
Middle Name:REINERT
Last Name:WERNER
Suffix:JR
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 1:2307 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-6601
Mailing Address - Country:US
Mailing Address - Phone:806-373-8351
Mailing Address - Fax:806-373-8147
Practice Address - Street 1:2307 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6601
Practice Address - Country:US
Practice Address - Phone:806-373-8351
Practice Address - Fax:806-373-8147
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23351Medicare UPIN