Provider Demographics
NPI:1821196536
Name:WEINER, PAUL ADAM (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ADAM
Last Name:WEINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 JOG RD
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2162
Mailing Address - Country:US
Mailing Address - Phone:561-265-5424
Mailing Address - Fax:561-265-5418
Practice Address - Street 1:15300 JOG RD
Practice Address - Street 2:SUITE # 204
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2162
Practice Address - Country:US
Practice Address - Phone:561-265-5424
Practice Address - Fax:561-265-5418
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-2873213E00000X
FLP02873213ES0103X
FLPO2873213ES0131X, 213ER0200X, 213ES0000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340244400Medicaid
65735AOtherBC
FL390218800Medicaid
480032707OtherRR MCR
65735OtherBC
P00108394OtherRR MCR
FL65735OtherBCBS
65735OtherBC
P00108394OtherRR MCR
4332430001Medicare NSC
65735AOtherBC
FL390218800Medicaid