Provider Demographics
NPI:1326190836
Name:WEISSBERG, JED IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:IRA
Last Name:WEISSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KAISER PLZ
Mailing Address - Street 2:27L
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3610
Mailing Address - Country:US
Mailing Address - Phone:510-271-6847
Mailing Address - Fax:
Practice Address - Street 1:39400 PASEO PADRE PARKWAY
Practice Address - Street 2:KP FREMONT MEDICAL CENTER
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-271-6847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology