Provider Demographics
NPI:1952700841
Name:WEINSTEIN, BRIAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 E ORCHARD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1726
Mailing Address - Country:US
Mailing Address - Phone:303-761-0906
Mailing Address - Fax:303-761-0907
Practice Address - Street 1:916 S MAIN ST UNIT 201
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6673
Practice Address - Country:US
Practice Address - Phone:303-761-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363AM0700X
VT055-0031310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTY400330148Medicare UPIN