Provider Demographics
NPI:1134137128
Name:WEINER, GILBERT R (DO)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:WEINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2505
Mailing Address - Country:US
Mailing Address - Phone:954-764-8911
Mailing Address - Fax:954-764-2150
Practice Address - Street 1:1130 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2505
Practice Address - Country:US
Practice Address - Phone:954-764-8911
Practice Address - Fax:954-764-2150
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDS1649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E32021Medicare UPIN