Provider Demographics
NPI:1538151808
Name:WEINER, BARRY EVAN (DPM)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:EVAN
Last Name:WEINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 J STREET
Mailing Address - Street 2:STE 270
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-5542
Mailing Address - Country:US
Mailing Address - Phone:916-454-3668
Mailing Address - Fax:916-454-9255
Practice Address - Street 1:3939 J STREET #270
Practice Address - Street 2:STE 270
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-5542
Practice Address - Country:US
Practice Address - Phone:916-454-3668
Practice Address - Fax:916-454-9255
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2459213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E24590Medicaid
CA000E24590Medicaid
CA0257780001Medicare NSC
CA000E24590Medicare ID - Type Unspecified