Provider Demographics
NPI:1518929991
Name:WEINER, EDWARD L (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:WEINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 SOUTHAMPTON TER
Mailing Address - Street 2:SUITE 412-F
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-9101
Mailing Address - Country:US
Mailing Address - Phone:954-721-6010
Mailing Address - Fax:954-721-6020
Practice Address - Street 1:7727 SOUTHAMPTON TER
Practice Address - Street 2:SUITE 412-F
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-9101
Practice Address - Country:US
Practice Address - Phone:954-721-6010
Practice Address - Fax:954-721-6020
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3137213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340507900Medicaid
FLT27374Medicare UPIN
FL340507900Medicaid