Provider Demographics
NPI:1376624387
Name:MARTIN E WEINER, M.D. P.A.
Entity Type:Organization
Organization Name:MARTIN E WEINER, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-875-2431
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-1068
Mailing Address - Country:US
Mailing Address - Phone:830-875-2431
Mailing Address - Fax:
Practice Address - Street 1:711 S HACKBERRY
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648
Practice Address - Country:US
Practice Address - Phone:830-875-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX827083679OtherRR MEDICARE
TX130954404Medicaid
TX130954404Medicaid
TX00MA29Medicare PIN