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General NPI Number Information
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NPI Number | 1134297385
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Entity Type | Individual
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Provider Name | IAN LANDON WEISBERG MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 550 REDSTONE AVE W STE 430
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City | CRESTVIEW
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State | FL
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Zip | 32536-6457
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Country | US
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Telephone | 850-854-3278
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Fax | 850-616-9164
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Provider Business Mailing Address
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Address Line | 550 REDSTONE AVE W STE 430
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City | CRESTVIEW
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State | FL
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Zip | 32536-6457
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Country | US
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Telephone | 850-854-3278
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Fax | 850-616-9164
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | MD32189
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | ME108041
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License Number State | FL
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