MEDICARE: GARY B WEINER MD CHARTERED

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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000016672	OTHER	KS	BCBS OF KS

General Provider Information

NPI Number	:	1497856223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY B WEINER MD CHARTERED

Provider Business Mailing Address
First Line	:	1410 E IRON AVE
Second Line	:	SUITE 5
City	:	SALINA
State	:	KS
Zip	:	67401-3285
Country	:	US
Telephone Number	:	785-825-7271
Fax Number	:	785-825-0957

Provider Business Practice Location Address
First Line	:	1410 E IRON AVE
Second Line	:	SUITE 5
City	:	SALINA
State	:	KS
Zip	:	67401-3285
Country	:	US
Telephone Number	:	785-825-7271
Fax Number	:	785-825-0957

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY B WEINER
Credential	:	M.D.
Telephone Number	:	785-825-7271

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/25/2013

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