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General NPI Number Information
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NPI Number | 1003801705
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Entity Type | Individual
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Provider Name | STANISLAV WEINER MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 703 E MARSHALL AVE STE 5008
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City | LONGVIEW
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State | TX
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Zip | 75601-5557
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Country | US
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Telephone | 903-315-4880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-324-6450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | L7248
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | L7248
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L7248
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License Number State | TX
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