=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679697296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD H WEINER DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 07/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4523 W LOVERS LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75209-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-351-2180
-----------------------------------------------------
Fax | 214-351-3886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4523 W LOVERS LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75209-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-351-2180
-----------------------------------------------------
Fax | 214-351-3886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN AND TREASURER
-----------------------------------------------------
Name | DR. RICHARD H WEINER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 214-351-2180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 0520
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------