Provider Demographics
NPI:1790751444
Name:WEINGOLD, DAVID HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARD
Last Name:WEINGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6621
Mailing Address - Country:US
Mailing Address - Phone:870-802-3376
Mailing Address - Fax:870-972-5140
Practice Address - Street 1:4334 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6621
Practice Address - Country:US
Practice Address - Phone:870-802-3376
Practice Address - Fax:870-972-5140
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR70013929OtherRAILROAD MEDICARE
AR5K355OtherARKANSAS BCBS
AR5K355OtherARKANSAS BCBS
AR70013929OtherRAILROAD MEDICARE