Provider Demographics
NPI:1982674743
Name:WEINRACH, JONATHAN C (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:WEINRACH
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 1:10229 N 92ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4562
Mailing Address - Country:US
Mailing Address - Phone:480-634-6014
Mailing Address - Fax:480-393-7246
Practice Address - Street 1:10229 N 92ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4562
Practice Address - Country:US
Practice Address - Phone:480-634-6014
Practice Address - Fax:480-393-7246
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ329582086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007834Medicaid
AZAZ0306350OtherBCBS
AZH93156Medicare UPIN
AZ109397Medicare PIN