Provider Demographics
NPI:1871575316
Name:WEINGARTEN, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-445-3235
Mailing Address - Fax:503-790-2293
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 238
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-223-7214
Practice Address - Fax:503-227-7572
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD19193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067350Medicaid
OR003335021OtherREGENCE BLUE CROSS OF OR
ORP00634935OtherRAILROAD MEDICARE/PALMETTO
011WFBPGJMedicare ID - Type Unspecified
ORP00634935OtherRAILROAD MEDICARE/PALMETTO