Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD61047604 | WA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD61047604 | WA |
NPI | 1104203793 |
---|---|
Provider Name | Dr. Eric Andrew Eisen |
First Address | Kirkland, WA 98034-7467 |
Second Address | Redmond, WA 98052-3858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2015 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2160928 | (05) | WA |
427413 | WA L&I (01) | WA |