Provider Demographics
NPI:1336118736
Name:WEINBERGER, BRUCE L (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:L
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:MD
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 50720
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0720
Mailing Address - Country:US
Mailing Address - Phone:806-467-0459
Mailing Address - Fax:806-355-1284
Practice Address - Street 1:700 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1607
Practice Address - Country:US
Practice Address - Phone:806-353-6691
Practice Address - Fax:806-355-1284
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99390901Medicaid
TX88628JOtherBCBS
TX88628JMedicare ID - Type Unspecified
88628JMedicare PIN
TX99390901Medicaid