Healthcare Provider Details

I. General information

NPI: 1811941107
Provider Name (Legal Business Name): JAN J. WEISBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PHYSICIANS PARK SUITE 4
FRANKFORT KY
40601-4163
US

IV. Provider business mailing address

5 PHYSICIANS PARK SUITE 4
FRANKFORT KY
40601-4163
US

V. Phone/Fax

Practice location:
  • Phone: 502-227-9911
  • Fax: 502-226-6455
Mailing address:
  • Phone: 502-227-9911
  • Fax: 502-226-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number26843
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: