Provider Demographics
NPI:1376813121
Name:WEINBERG GASTROINTESTINAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:WEINBERG GASTROINTESTINAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-745-3690
Mailing Address - Street 1:10401 E MCDOWELL MOUNTAIN RANCH RD
Mailing Address - Street 2:#2-352
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8698
Mailing Address - Country:US
Mailing Address - Phone:480-745-3690
Mailing Address - Fax:480-745-3697
Practice Address - Street 1:4915 E. BASELINE RD.
Practice Address - Street 2:#126
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-745-3690
Practice Address - Fax:480-345-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4699207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ263066Medicaid