Provider Demographics
NPI:1568978500
Name:WEINSTEIN, JOHN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2806
Mailing Address - Country:US
Mailing Address - Phone:832-331-1504
Mailing Address - Fax:
Practice Address - Street 1:817 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2806
Practice Address - Country:US
Practice Address - Phone:832-331-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice