Provider Demographics
NPI:1417986670
Name:DAVID S. WEINGARTEN, M.D., PC
Entity Type:Organization
Organization Name:DAVID S. WEINGARTEN, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-440-6312
Mailing Address - Street 1:1813 W HARVARD AVE STE 422
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-8705
Mailing Address - Country:US
Mailing Address - Phone:541-440-6312
Mailing Address - Fax:541-677-6125
Practice Address - Street 1:1813 W HARVARD AVE STE 422
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-8705
Practice Address - Country:US
Practice Address - Phone:541-440-6312
Practice Address - Fax:541-677-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067350Medicaid