Provider Demographics
NPI:1235376575
Name:MARK B WEINSTEIN, M.D.,P.A.
Entity Type:Organization
Organization Name:MARK B WEINSTEIN, M.D.,P.A.
Other - Org Name:SAN ANTONIO SKIN AND CANCER CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-3575
Mailing Address - Street 1:7950 FLOYD CURL DRIVE
Mailing Address - Street 2:SUITE 909
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3972
Mailing Address - Country:US
Mailing Address - Phone:210-614-3575
Mailing Address - Fax:210-692-7116
Practice Address - Street 1:7950 FLOYD CURL DRIVE
Practice Address - Street 2:SUITE 909
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3972
Practice Address - Country:US
Practice Address - Phone:210-614-3575
Practice Address - Fax:210-692-7116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK B WEINSTEIN, M.D.,P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032269501Medicaid
TX=========OtherEIN
TX=========OtherEIN
TXE02280Medicare PIN