Basic Information
| Provider Information | |||||||||
| NPI: | 1154373710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEISBERG | ||||||||
| FirstName: | RONALD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1525 NW 62ND ST | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333091831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009437526 | ||||||||
| FaxNumber: | 9548511746 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 LINTON BLVD | ||||||||
| Address2: | BLDG B | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334456584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614959111 | ||||||||
| FaxNumber: | 5614956766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME0066132 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 376041300 | 05 | FL | MEDICAID |