Provider Demographics
NPI:1609804426
Name:WEINBERG, PAUL S (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:WEINBERG
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 1:18620 E CACTUS HILL RD
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6212
Mailing Address - Country:US
Mailing Address - Phone:805-712-6613
Mailing Address - Fax:
Practice Address - Street 1:436 5TH & TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0043
Practice Address - Country:US
Practice Address - Phone:907-442-3321
Practice Address - Fax:907-442-7250
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27031207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19IPMedicaid
CAOOG270310Medicaid
AKHS19OPMedicaid
AKHS19OPMedicaid
AK021310Medicare Oscar/Certification
AKHS19IPMedicaid
CAWG27031AMedicare ID - Type Unspecified
CAOOG270310Medicaid