Healthcare Provider Details

I. General information

NPI: 1144269226
Provider Name (Legal Business Name): MARTIN E WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HAYS ST
LULING TX
78648-3207
US

IV. Provider business mailing address

711 S HACKBERRY AVE
LULING TX
78648-3200
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF4666
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF4666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: