Healthcare Provider Details

I. General information

NPI: 1336333251
Provider Name (Legal Business Name): LESLIE WEISBERG, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 W PARKER RD STE 220
PLANO TX
75093-8100
US

IV. Provider business mailing address

6300 W PARKER RD STE 220
PLANO TX
75093-8100
US

V. Phone/Fax

Practice location:
  • Phone: 972-981-8215
  • Fax: 972-981-8038
Mailing address:
  • Phone: 972-981-8215
  • Fax: 972-981-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberJ2999
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ2999
License Number StateTX

VIII. Authorized Official

Name: MRS. LISA PRATER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 972-981-8345