Provider Demographics
NPI:1720309263
Name:WEIR, GINA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:LEIGH
Last Name:WEIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:LEIGH
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6969 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2835
Mailing Address - Country:US
Mailing Address - Phone:402-413-7460
Mailing Address - Fax:402-413-7486
Practice Address - Street 1:6969 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2835
Practice Address - Country:US
Practice Address - Phone:402-413-7460
Practice Address - Fax:402-413-7486
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073374004Medicaid
099150OtherMEDICARE PTAN