Provider Demographics
NPI:1053312835
Name:EISENBERG, HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 N WYATT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6118
Mailing Address - Country:US
Mailing Address - Phone:520-795-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:6261 N LA CHOLLA BLVD STE 277
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3564
Practice Address - Country:US
Practice Address - Phone:520-877-3800
Practice Address - Fax:520-877-3801
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0770300OtherBCBS
AZ166357Medicaid
AZ2Z1958OtherHEALTHNET
AZ4609404OtherAETNA
AZ102824Medicare ID - Type Unspecified
AZ166357Medicaid