Provider Demographics
NPI:1730133448
Name:WEINER, RONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CENTRE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2862
Mailing Address - Country:US
Mailing Address - Phone:731-512-0104
Mailing Address - Fax:731-668-7388
Practice Address - Street 1:17 CENTRE PLAZA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2862
Practice Address - Country:US
Practice Address - Phone:731-512-0104
Practice Address - Fax:731-668-7388
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1124207RC0000X
TNDO1124207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN060053873OtherRAILROAD MEDICARE
TN3122211OtherBCBS PROVIDER NUMBER
TN5339059OtherAETNA PROVIDER NUMBER
TN1952206OtherCIGNA HEALTHCARE
TN3304299Medicaid
TN5010926OtherTLC PROVIDER
TN6238568OtherBCBST
TN3122211OtherBCBS PROVIDER NUMBER