Provider Demographics
NPI:1073696126
Name:SCOTT R WEISBERG MD, PC
Entity Type:Organization
Organization Name:SCOTT R WEISBERG MD, PC
Other - Org Name:HOMEWOOD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF PC
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-877-8677
Mailing Address - Street 1:2151 HIGHLAND AVE S
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4079
Mailing Address - Country:US
Mailing Address - Phone:205-877-8677
Mailing Address - Fax:205-877-8675
Practice Address - Street 1:2151 HIGHLAND AVE S
Practice Address - Street 2:SUITE 320
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4079
Practice Address - Country:US
Practice Address - Phone:205-877-8677
Practice Address - Fax:205-877-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK373Medicare ID - Type Unspecified