MEDICARE: GERALD STANLEY WEINSTEIN 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	2086S0129X	Vascular Surgery Physician	2001121	NM
2	2086S0129X	Vascular Surgery Physician	MD043777L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NM009337	OTHER	NM	BCBS OF NM

General Provider Information

NPI Number	:	1477552982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD STANLEY WEINSTEIN M.D.

Provider Business Mailing Address
First Line	:	1631 HOSPITAL DR
Second Line	:	SUITE 240
City	:	SANTA FE
State	:	NM
Zip	:	87505-4728
Country	:	US
Telephone Number	:	505-913-3975
Fax Number	:	505-946-8001

Provider Business Practice Location Address
First Line	:	1631 HOSPITAL DR
Second Line	:	SUITE 240
City	:	SANTA FE
State	:	NM
Zip	:	87505-4728
Country	:	US
Telephone Number	:	505-913-3975
Fax Number	:	505-946-8001

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/05/2010

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Directions to “ GERALD STANLEY WEINSTEIN M.D.” Practice Location

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