MEDICARE: STEPHEN A WEINBERG M.D.

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	174400000X	Specialist	G6421	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00CQ57	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1417996984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN A WEINBERG M.D.

Provider Business Mailing Address
First Line	:	3300 COLORADO BLVD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-6864
Country	:	US
Telephone Number	:	940-566-2440
Fax Number	:	940-566-0180

Provider Business Practice Location Address
First Line	:	3300 COLORADO BLVD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-6864
Country	:	US
Telephone Number	:	940-566-2440
Fax Number	:	940-566-0180

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/09/2007

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