Provider Demographics
NPI:1215910096
Name:WERNER, BRYAN C (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:C
Last Name:WERNER
Suffix:
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 1:3150 N TENAYA WAY STE 455
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0460
Mailing Address - Country:US
Mailing Address - Phone:702-962-9550
Mailing Address - Fax:
Practice Address - Street 1:3150 N TENAYA WAY STE 455
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0460
Practice Address - Country:US
Practice Address - Phone:702-962-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13607208100000X
CAPENDING208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN