Provider Demographics
NPI:1578388229
Name:EMERALD COAST HEART & AFIB, PLLC
Entity type:Organization
Organization Name:EMERALD COAST HEART & AFIB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:LANDON
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-854-3278
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:
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:850-602-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty