Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | MD32189 | AL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | ME108041 | FL |
NPI | 1134297385 |
---|---|
Provider Name | Ian Landon Weisberg |
First Address | Pensacola, FL 32501-6339 |
Second Address | Pensacola, FL 32501-6339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 05/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134297385 | (05) | AL |
2678300 | (05) | FL |