Provider Demographics
NPI:1871548479
Name:WERNER, GLENN L (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:L
Last Name:WERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1264 RIBAUT ROAD
Mailing Address - Street 2:BLDG 200
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902
Mailing Address - Country:US
Mailing Address - Phone:843-524-5455
Mailing Address - Fax:843-524-5655
Practice Address - Street 1:1264 RIBAUT ROAD
Practice Address - Street 2:BLDG 200
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-524-5455
Practice Address - Fax:843-524-5655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC15977207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3884Medicaid
SCGP3884Medicaid
BO07393Medicare UPIN