Provider Demographics
NPI:1972566339
Name:WEINER, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:WEINER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:632 DEL PRADO BLVD N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2278
Mailing Address - Country:US
Mailing Address - Phone:239-772-5577
Mailing Address - Fax:239-772-9961
Practice Address - Street 1:12700 CREEKSIDE LN
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:239-432-0774
Practice Address - Fax:239-432-9404
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-01-07
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Provider Licenses
StateLicense IDTaxonomies
FLME76902208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2552329-00Medicaid
FL44520OtherBCBS
FL2552329-00Medicaid
FL1290460001Medicare NSC