Provider Demographics
NPI:1326127408
Name:WEINER, IRA (DPM)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:WEINER
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:PO BOX 93423
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-3423
Mailing Address - Country:US
Mailing Address - Phone:702-389-5360
Mailing Address - Fax:702-389-5360
Practice Address - Street 1:9260 W SUNSET RD STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-389-5360
Practice Address - Fax:702-829-8420
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9205213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102788Medicaid
NV10979OtherNEVADACARE
1078320OtherUNITED HC
860864650OtherTAX ID
NV002102788OtherNV HEALTH SOLUTIONS
480029440OtherRR MEDICARE
8608645001OtherCULINARY
10339OtherPACIFICARE
NV002102788OtherNV KIDS
0608272OtherAETNA
860864650OtherUFCW
860864650OtherTAX ID
NVV31759Medicare ID - Type Unspecified