1992765234 NPI number — ELEISE LA PORTA WEISBERG MD

Table of content: ELEISE LA PORTA WEISBERG MD (NPI 1992765234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992765234 NPI number — ELEISE LA PORTA WEISBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISBERG
Provider First Name:
ELEISE
Provider Middle Name:
LA PORTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LA PORTA
Provider Other First Name:
ELEISE
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992765234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7212 INDEPENDENCE PKWY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-5763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-618-2493
Provider Business Mailing Address Fax Number:
972-618-4297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7212 INDEPENDENCE PKWY STE A
Provider Second Line Business Practice Location Address:
PEDIATRICS AFTER HOURS
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75025-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-618-2493
Provider Business Practice Location Address Fax Number:
972-618-4297
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L9774 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 167994602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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