Provider Demographics
NPI:1902938616
Name:WEISBUCH, JONATHAN BERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BERMAN
Last Name:WEISBUCH
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 1:2210 ENCANTO DR NW
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1518
Mailing Address - Country:US
Mailing Address - Phone:602-528-3850
Mailing Address - Fax:
Practice Address - Street 1:2210 ENCANTO DR NW
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1518
Practice Address - Country:US
Practice Address - Phone:602-528-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA555812083P0901X
CAG672102083P0901X
AZ288142083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine