Provider Demographics
NPI:1578566238
Name:WEINER, RICHARD H (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
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 1:4523 W LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3131
Mailing Address - Country:US
Mailing Address - Phone:214-351-2180
Mailing Address - Fax:214-351-3886
Practice Address - Street 1:4523 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3131
Practice Address - Country:US
Practice Address - Phone:214-351-2180
Practice Address - Fax:214-351-3886
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-04-06
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
TX0520213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119891305Medicaid
TX282978001OtherMEDICAID TPI BILLING PROVIDER
TX1679697296OtherMEDICARE GROUP BILLING NPI
TX0A5725OtherMEDICARE PTAN
TX1679697296OtherMEDICARE GROUP BILLING NPI