Provider Demographics
NPI:1093797367
Name:EIDT, HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:EIDT
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:26730 CROWN VALLEY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8001
Mailing Address - Country:US
Mailing Address - Phone:949-364-2154
Mailing Address - Fax:949-364-2110
Practice Address - Street 1:26730 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6364
Practice Address - Country:US
Practice Address - Phone:949-364-2154
Practice Address - Fax:949-364-2110
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2020-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101102750207X00000X
GA57605207X00000X
CAC54254207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery