Provider Demographics
NPI:1083773246
Name:EISENHAUER, LAWRENCE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:EISENHAUER
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 1:320 SANTA FE DR
Mailing Address - Street 2:STE LL4
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-753-8413
Mailing Address - Fax:760-753-5351
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:STE LL4
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-753-8413
Practice Address - Fax:760-753-5351
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG036375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46668Medicare UPIN