Individual
MATTHEW RYAN WEISSENBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4450 SOJOURN DR STE 200, ADDISON, TX 75001-5000
(972) 733-0014
(972) 733-0125
Mailing address
PO BOX 678253, DALLAS, TX 75267-8253
(800) 841-4236
(706) 653-1230
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
Q4333
TX
2085R0204X
Vascular & Interventional Radiology Physician
Q4333
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398449405
—
TX
Enumeration date
04/21/2013
Last updated
02/21/2025
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