Healthcare Provider Details

I. General information

NPI: 1053384834
Provider Name (Legal Business Name): ANDREW WEINBERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 E IRMA LN
PHOENIX AZ
85050-4312
US

IV. Provider business mailing address

4375 E IRMA LN
PHOENIX AZ
85050-4312
US

V. Phone/Fax

Practice location:
  • Phone: 480-890-5800
  • Fax: 480-890-5920
Mailing address:
  • Phone: 480-890-5800
  • Fax: 480-890-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4699
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: