Provider Demographics
NPI:1134297385
Name:WEISBERG, IAN LANDON (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:LANDON
Last Name:WEISBERG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 REDSTONE AVE W STE 430
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6457
Mailing Address - Country:US
Mailing Address - Phone:850-854-3278
Mailing Address - Fax:850-616-9164
Practice Address - Street 1:550 REDSTONE AVE W STE 430
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6457
Practice Address - Country:US
Practice Address - Phone:850-854-3278
Practice Address - Fax:850-616-9164
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD32189207RC0001X
FLME108041207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1134297385Medicaid
FL2678300Medicaid
FL2678300Medicaid
AL102I210477Medicare PIN