Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 59481 | AZ |
N | 207Q00000X | Family Doctor | RS2017-0457 | NM |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD2019-0662 | NM |
NPI | 1366972135 |
---|---|
Provider Name | Dr. Jamie Drew Weinand X |
First Address | Tucson, AZ 85730-1017 |
Second Address | Tucson, AZ 85730-1017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59481 | MEDICAL LICENSE (01) | AZ |
CS00227635 | NEW MEXICO CONTROLLED SUBSTANCE LICENSE (01) | NM |
FW8732718 | DEA - ARIZONA (01) | AZ |
FW9334397 | DEA - NEW MEXICO DEPARTMENT OF HEALTH ONLY, FEE EXEMPT******* (01) | NM |
MD2019-0662 | NEW MEXICO MEDICAL LICENSE (01) | NM |
XW8732718 | DEAX (SAMHSA, BUPRENORPHINE WAIVER) (01) |