MEDICARE: RONALD A. WEINTRAUB, MD PA

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1164572087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD A. WEINTRAUB, MD PA

Provider Business Mailing Address
First Line	:	9441 LBJ FWY STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4500
Country	:	US
Telephone Number	:	972-664-6963
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 39TH ST
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-2905
Country	:	US
Telephone Number	:	972-664-6900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD WEINTRAUB
Credential	:	MD
Telephone Number	:	409-962-5733

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	06/27/2008

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