Healthcare Provider Details

I. General information

NPI: 1679697296
Provider Name (Legal Business Name): RICHARD H WEINER DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 W LOVERS LN
DALLAS TX
75209-3131
US

IV. Provider business mailing address

4523 W LOVERS LN
DALLAS TX
75209-3131
US

V. Phone/Fax

Practice location:
  • Phone: 214-351-2180
  • Fax: 214-351-3886
Mailing address:
  • Phone: 214-351-2180
  • Fax: 214-351-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0520
License Number StateTX

VIII. Authorized Official

Name: DR. RICHARD H WEINER
Title or Position: CHAIRMAN AND TREASURER
Credential: DPM
Phone: 214-351-2180