Provider Demographics
NPI:1992728737
Name:WEINER, STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CALLE DE LA VUELTA
Mailing Address - Street 2:C-103
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4742
Mailing Address - Country:US
Mailing Address - Phone:505-982-5014
Mailing Address - Fax:505-982-2687
Practice Address - Street 1:2100 CALLE DE LA VUELTA
Practice Address - Street 2:C-103
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4742
Practice Address - Country:US
Practice Address - Phone:505-982-5014
Practice Address - Fax:505-982-2687
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78-95207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18952Medicaid
NM18952Medicaid