Provider Demographics
NPI:1053511279
Name:EISENBERG, LAUREN NICOLE (D,O)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:D,O
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 REMCON CIR
Mailing Address - Street 2:BLDG. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3508
Mailing Address - Country:US
Mailing Address - Phone:915-532-8823
Mailing Address - Fax:915-532-5909
Practice Address - Street 1:7420 REMCON CIRCLE
Practice Address - Street 2:BLDG. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-532-8823
Practice Address - Fax:915-532-5909
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8645208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN8645Other1053511279