Provider Demographics
NPI:1952332835
Name:WEINER, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:WEINER
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0468
Mailing Address - Country:US
Mailing Address - Phone:808-645-0015
Mailing Address - Fax:808-332-7837
Practice Address - Street 1:4489 PAPALINA RD
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8503
Practice Address - Country:US
Practice Address - Phone:808-332-8523
Practice Address - Fax:808-332-7050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-2925208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0040574OtherHMSA
HI99-0262194OtherHMAA
HI03687101Medicaid
0000282897OtherHMSA
HI036871-05Medicaid
HI03687101OtherALOHACARE
HI99-0262194OtherUHA
HIC97658OtherKAISER
BI685ZMedicare PIN
HIC97658OtherKAISER
HI100018Medicare ID - Type Unspecified