Provider Demographics
NPI:1417996984
Name:WEINBERG, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:WEINBERG
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 1:3300 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6864
Mailing Address - Country:US
Mailing Address - Phone:940-566-2440
Mailing Address - Fax:940-566-0180
Practice Address - Street 1:3300 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6864
Practice Address - Country:US
Practice Address - Phone:940-566-2440
Practice Address - Fax:940-566-0180
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CQ57OtherBLUE CROSS BLUE SHIELD TX
TX00CQ57OtherBLUE CROSS BLUE SHIELD TX
TX00CQ57Medicare ID - Type UnspecifiedMEDICARE