MEDICARE: IRA LEWIS WEINER 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	2084P0800X	Psychiatry Physician	ME82807	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME82807	OTHER	FL	MEDICAL LICENSE #
2	81168	OTHER	FL	BCBSF PROV#

General Provider Information

NPI Number	:	1770580409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRA LEWIS WEINER M.D.

Provider Business Mailing Address
First Line	:	345 MOONLIGHT BAY DRIVE
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407
Country	:	US
Telephone Number	:	850-236-8862
Fax Number	:	850-236-8862

Provider Business Practice Location Address
First Line	:	345 MOONLIGHT BAY DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2860
Country	:	US
Telephone Number	:	850-236-8862
Fax Number	:	850-236-8862

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/07/2023

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