Provider Demographics
NPI:1871655902
Name:WEISBERG, ERIC LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LAWRENCE
Last Name:WEISBERG
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 1:4685 ELDORADO PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-335-2727
Mailing Address - Fax:
Practice Address - Street 1:4685 ELDORADO PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-335-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2867207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612950Medicare PIN