Provider Demographics
NPI:1992765234
Name:WEISBERG, ELEISE LA PORTA (MD)
Entity type:Individual
Prefix:
First Name:ELEISE
Middle Name:LA PORTA
Last Name:WEISBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELEISE
Other - Middle Name:BETH
Other - Last Name:LA PORTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7212 INDEPENDENCE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5763
Mailing Address - Country:US
Mailing Address - Phone:972-618-2493
Mailing Address - Fax:972-618-4297
Practice Address - Street 1:7212 INDEPENDENCE PKWY STE A
Practice Address - Street 2:PEDIATRICS AFTER HOURS
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5763
Practice Address - Country:US
Practice Address - Phone:972-618-2493
Practice Address - Fax:972-618-4297
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167994602Medicaid
TX167994602Medicaid
I23605Medicare UPIN