1407026784 NPI number — JONATHAN WEINSTEIN, MD PA

Table of content: (NPI 1407026784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407026784 NPI number — JONATHAN WEINSTEIN, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN WEINSTEIN, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407026784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5757 WARREN PKWY
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-4274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-824-2547
Provider Business Mailing Address Fax Number:
214-618-8038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 WARREN PKWY
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-4274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-824-2547
Provider Business Practice Location Address Fax Number:
214-618-8038
Provider Enumeration Date:
03/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEINSTEIN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-824-2547

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  L5181 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172494001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156812002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".