Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2009004523 | MO |
Y | 207VG0400X | Gynecologist | 2009004523 | MO |
NPI | 1033304415 |
---|---|
Provider Name | Dr. David L Eisenberg |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63108-1495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209352400 | (05) | MO |