Healthcare Provider Details

I. General information

NPI: 1992728737
Provider Name (Legal Business Name): STEVEN WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CALLE DE LA VUELTA C-103
SANTA FE NM
87505-4742
US

IV. Provider business mailing address

2100 CALLE DE LA VUELTA C-103
SANTA FE NM
87505-4742
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-5014
  • Fax: 505-982-2687
Mailing address:
  • Phone: 505-982-5014
  • Fax: 505-982-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number78-95
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: