Healthcare Provider Details

I. General information

NPI: 1174633937
Provider Name (Legal Business Name): BARRY GERALD WEINSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD PECOS TRAIL STE P
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 2469
SANTA FE NM
87504-2469
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-0358
  • Fax: 505-466-1257
Mailing address:
  • Phone: 505-820-0358
  • Fax: 505-466-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number85121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: