Provider Demographics
NPI:1477552982
Name:WEINSTEIN, GERALD STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:STANLEY
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1631 HOSPITAL DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4728
Mailing Address - Country:US
Mailing Address - Phone:505-913-3975
Mailing Address - Fax:505-946-8001
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-913-3975
Practice Address - Fax:505-946-8001
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20011212086S0129X
PAMD043777L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012356470006Medicaid
NMA6265Medicaid
NMNM009337OtherBCBS OF NM
NM342414000Medicare PIN