Provider Demographics
NPI:1043694235
Name:WEINTRUB, BRENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:WEINTRUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E RAY RD STE 128
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4206
Mailing Address - Country:US
Mailing Address - Phone:480-497-3946
Mailing Address - Fax:480-497-3947
Practice Address - Street 1:633 E RAY RD STE 128
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:480-497-3946
Practice Address - Fax:480-497-3947
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZPOD-000901213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program