Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 77-154 | NM |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 77-154 | NM |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 77-154 | NM |
N | 2086S0122X | Plastic and Reconstructive Surgery | 77-154 | NM |
NPI | 1841329216 |
---|---|
Provider Name | Dr. Karl Joseph Eisbach |
First Address | Albuquerque, NM 87110-7552 |
Second Address | Albuquerque, NM 87110-7552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C97737 | (02) | NM |