Provider Demographics
NPI:1831519826
Name:WEINER-JOHNSON, CANDICE (MD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:WEINER-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:908 ROCKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8966
Mailing Address - Country:US
Mailing Address - Phone:512-868-0901
Mailing Address - Fax:512-868-1527
Practice Address - Street 1:908 ROCKMOOR DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8966
Practice Address - Country:US
Practice Address - Phone:512-868-0901
Practice Address - Fax:512-868-1527
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8844207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine