Provider Demographics
NPI:1891740338
Name:WEINROBE, MARK C (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:WEINROBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:215 E HAWAII AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6011
Mailing Address - Country:US
Mailing Address - Phone:208-463-3244
Mailing Address - Fax:208-463-3388
Practice Address - Street 1:7272 W POTOMAC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9149
Practice Address - Country:US
Practice Address - Phone:208-463-3000
Practice Address - Fax:208-884-2979
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM7808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1891740338Medicaid
ID20005641Medicare PIN
ID806104600Medicaid