Provider Demographics
NPI:1871555086
Name:WEINER, GERALD H (M D)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:H
Last Name:WEINER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 E ALAN LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253
Mailing Address - Country:US
Mailing Address - Phone:480-483-1655
Mailing Address - Fax:480-483-0203
Practice Address - Street 1:5407 E ALAN LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253
Practice Address - Country:US
Practice Address - Phone:480-483-1655
Practice Address - Fax:480-483-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD5502207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167214Medicaid
D68324Medicare UPIN
AZ167214Medicaid