=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477501724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY I WEINGARDEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 05/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 399 W CAMPBELL RD SUITE 300
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-699-3508
-----------------------------------------------------
Fax | 972-699-8281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16980 DALLAS PKWY SUITE 200
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-1974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-699-3508
-----------------------------------------------------
Fax | 972-699-8281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | G2242
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------