Provider Demographics
NPI:1053383463
Name:WEINER, MATTHEW JEREMY (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JEREMY
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 1:5155 E FARNESS DR STE 111A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2158
Mailing Address - Country:US
Mailing Address - Phone:520-298-3300
Mailing Address - Fax:520-800-1055
Practice Address - Street 1:5155 E FARNESS DR STE 111A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2158
Practice Address - Country:US
Practice Address - Phone:520-298-3300
Practice Address - Fax:520-800-1055
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57146208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020F392060OtherBCBSM/BCN