Provider Demographics
NPI:1962473769
Name:WESTON, KOREN (MD)
Entity type:Individual
Prefix:DR
First Name:KOREN
Middle Name:
Last Name:WESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KOREN
Other - Middle Name:
Other - Last Name:DINGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11149 RESEARCH BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5279
Mailing Address - Country:US
Mailing Address - Phone:512-231-1901
Mailing Address - Fax:512-231-1902
Practice Address - Street 1:2200 PARK BEND DR STE 204
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:855-481-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4802208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156536803Medicaid
TX156536802Medicaid
TX156536804Medicaid
TX156536804Medicaid
TX8L2050Medicare PIN
TX8C7848Medicare PIN
TX156536802Medicaid