Provider Demographics
NPI:1376649012
Name:WEINGARTEN, RANDALL TODD (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:TODD
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50007
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0007
Mailing Address - Country:US
Mailing Address - Phone:702-617-9599
Mailing Address - Fax:702-256-3637
Practice Address - Street 1:11201 S EASTERN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6201
Practice Address - Country:US
Practice Address - Phone:702-617-9599
Practice Address - Fax:702-614-8937
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8716207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F20461Medicare UPIN