Healthcare Provider Details

I. General information

NPI: 1689640542
Provider Name (Legal Business Name): ROBERT IRA WINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 COLUMBINE AVE
BOULDER CO
80302
US

IV. Provider business mailing address

1510 COLUMBINE AVE
BOULDER CO
80302-7943
US

V. Phone/Fax

Practice location:
  • Phone: 303-586-1556
  • Fax: 303-747-5726
Mailing address:
  • Phone: 303-841-9863
  • Fax: 844-872-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD023070E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number46748
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD023070E
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46748
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: