Basic Information
| Provider Information | |||||||||
| NPI: | 1619957008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINSTEIN | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | HOLLIS | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3487 S MERCY RD | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852970430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802225601 | ||||||||
| FaxNumber: | 4802225607 | ||||||||
| Practice Location | |||||||||
| Address1: | 3487 S MERCY RD | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852970430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802225601 | ||||||||
| FaxNumber: | 4802225607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 33990 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 961426 | 05 | AZ | MEDICAID |