Provider Demographics
NPI:1003845249
Name:WEINER, GARETH R (MD)
Entity Type:Individual
Prefix:
First Name:GARETH
Middle Name:R
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3333S WADSWORTH BLVD D100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5117
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-5534
Practice Address - Street 1:10001 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2050
Practice Address - Country:US
Practice Address - Phone:303-252-4442
Practice Address - Fax:303-429-6714
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO29683207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01296839Medicaid
CO100009339OtherRAILROAD MEDICARE
CO100009339OtherRAILROAD MEDICARE
COE19618Medicare UPIN