1326127408 NPI number — IRA WEINER DPM

Table of content: IRA WEINER DPM (NPI 1326127408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326127408 NPI number — IRA WEINER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINER
Provider First Name:
IRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1326127408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93423
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-389-5360
Provider Business Mailing Address Fax Number:
702-389-5360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9260 W SUNSET RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-389-5360
Provider Business Practice Location Address Fax Number:
702-829-8420
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  9205 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002102788 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10979 . This is a "NEVADACARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1078320 . This is a "UNITED HC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 860864650 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002102788 . This is a "NV HEALTH SOLUTIONS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 480029440 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8608645001 . This is a "CULINARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10339 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002102788 . This is a "NV KIDS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 0608272 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 860864650 . This is a "UFCW" identifier . This identifiers is of the category "OTHER".




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