MEDICARE: DR. BRENT WEINTRUB DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	POD-000901	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043694235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT WEINTRUB DPM

Provider Business Mailing Address
First Line	:	2915 E BASELINE RD STE 203
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2425
Country	:	US
Telephone Number	:	480-962-4281
Fax Number	:	480-962-1211

Provider Business Practice Location Address
First Line	:	4365 E PECOS RD STE 105
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-7888
Country	:	US
Telephone Number	:	480-962-4281
Fax Number	:	480-962-1211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	06/01/2026

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