Provider Demographics
NPI:1568400083
Name:WEISBERG, LESLIE A (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:WEISBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W PARKER RD
Mailing Address - Street 2:STE 220
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8168
Mailing Address - Country:US
Mailing Address - Phone:972-981-8215
Mailing Address - Fax:972-981-3099
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:STE 220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-8215
Practice Address - Fax:972-981-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2999207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00076DOtherBCBS
TX096287002Medicaid
TXP00073709OtherRAILROAD MEDICARE
TX5276560OtherAETNA
TXP00073709OtherRAILROAD MEDICARE
TX00076DMedicare PIN