Provider Demographics
NPI:1134240625
Name:WEINER, JORDAN SETH (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:SETH
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-273-8688
Mailing Address - Fax:480-273-8689
Practice Address - Street 1:8952 E DESERT COVE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-273-8688
Practice Address - Fax:480-273-8689
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ26108207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ425224Medicaid
AZWDCFPMedicare ID - Type UnspecifiedAZ OTOLARYNGOLOGY CENTER
AZZ28880Medicare ID - Type UnspecifiedAZ OTOLARYNGOLOGY CENTER
AZG18900Medicare UPIN
AZ425224Medicaid