Provider Demographics
NPI:1467566703
Name:WEINSTOCK, LEONARD B (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:B
Last Name:WEINSTOCK
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 1:11525 OLDE CABIN RD
Mailing Address - Street 2:SPECIALISTS IN GASTROENTEROLOGY
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7146
Mailing Address - Country:US
Mailing Address - Phone:314-997-0554
Mailing Address - Fax:314-997-5086
Practice Address - Street 1:11525 OLDE CABIN RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7146
Practice Address - Country:US
Practice Address - Phone:314-997-0554
Practice Address - Fax:314-997-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F99207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002012657OtherMEDICARE LEGACY
100008439OtherRAILROAD MEDICARE
107243OtherBLUE CROSS/BLUE SHIELD
42990OtherGHP
MO202409504Medicaid
4040860OtherAETNA
746435OtherUHC
13526OtherHEALTHLINK
4040860OtherAETNA