=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023345626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. WEINSTEIN, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2009
-----------------------------------------------------
Last Update Date | 10/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5575 WARREN PKWY SUITE 116
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-4062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-668-8300
-----------------------------------------------------
Fax | 972-668-8301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5575 WARREN PKWY SUITE 116
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-4062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-668-8300
-----------------------------------------------------
Fax | 972-668-8301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JONATHAN ROBERT WEINSTEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-668-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | L5181
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------