Provider Demographics
NPI:1336143213
Name:WEINER, GARY B (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1410 E IRON AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3285
Mailing Address - Country:US
Mailing Address - Phone:785-825-7271
Mailing Address - Fax:785-825-0957
Practice Address - Street 1:1410 E IRON AVE
Practice Address - Street 2:STE 5
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3285
Practice Address - Country:US
Practice Address - Phone:785-825-7271
Practice Address - Fax:785-825-0957
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0423696207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF47405Medicare UPIN
KS0000047185Medicare ID - Type Unspecified