Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 17169 | GA |
NPI | 1053301390 |
---|---|
Provider Name | Dr. Robert Michael Eisenband |
First Address | Atlanta, GA 30309-3276 |
Second Address | Atlanta, GA 30342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 05/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00066569D | (05) | GA |
D29384 | (02) | GA |