Provider Demographics
NPI:1649234642
Name:WEINER, BRADLEY K (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:K
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-9000
Mailing Address - Fax:713-790-2058
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-9000
Practice Address - Fax:713-790-2058
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5578207X00000X
PAMD420540207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328905001Medicaid
601771109OtherUS DEPT OF LABOR
TXP01070474OtherRR MEDICARE
616771105OtherUS DEPT OF LABOR
616771101OtherUS DEPT OF LABOR
616771110OtherUS DEPT OF LABOR
8W4761OtherBCBS
P00390793OtherRAILROAD MEDICARE
TXP01382178OtherRR MEDICARE
TXP01382178OtherRR MEDICARE
8W4761OtherBCBS
P00390793OtherRAILROAD MEDICARE