Provider Demographics
NPI:1760633473
Name:RICHARD B WEISBERG PA
Entity Type:Organization
Organization Name:RICHARD B WEISBERG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-221-7789
Mailing Address - Street 1:3511 SE WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5059
Mailing Address - Country:US
Mailing Address - Phone:772-221-7789
Mailing Address - Fax:772-221-8584
Practice Address - Street 1:1141 SE INDIAN ST STE 101
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5764
Practice Address - Country:US
Practice Address - Phone:772-221-7789
Practice Address - Fax:772-221-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271107900Medicaid
FL271107900Medicaid