Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD431428 | PA |
N | 208000000X | Pediatrician | ME90290 | FL |
NPI | 1396763439 |
---|---|
Provider Name | Dr. Evan Weiner |
First Address | Philadelphia, PA 19134-1043 |
Second Address | Philadelphia, PA 19134-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 12/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2711630-00 | (05) | FL |
I23709 | (02) | FL |