Healthcare Provider Details

I. General information

NPI: 1043694235
Provider Name (Legal Business Name): BRENT WEINTRUB DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 E PECOS RD STE 105
GILBERT AZ
85295-7888
US

IV. Provider business mailing address

2915 E BASELINE RD STE 203
GILBERT AZ
85234-2425
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-4281
  • Fax: 480-962-1211
Mailing address:
  • Phone: 480-962-4281
  • Fax: 480-962-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-000901
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: