Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | L5611 | TX |
NPI | 1003856360 |
---|---|
Provider Name | Scott J Weiner |
First Address | Galveston, TX 77555-5302 |
Second Address | Austin, TX 78701-1954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G34237 | (02) | TX |