Provider Demographics
NPI:1427016773
Name:WEINTRAUB, RICHARD MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1628
Mailing Address - Country:US
Mailing Address - Phone:970-298-1977
Mailing Address - Fax:
Practice Address - Street 1:DEPT #0861
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80256-0001
Practice Address - Country:US
Practice Address - Phone:866-898-7136
Practice Address - Fax:616-975-9824
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22052207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01220524Medicaid
UTT0569Medicaid
P00038636OtherRAILROAD
P00038636OtherRAILROAD
UTT0569Medicaid