Provider Demographics
NPI:1164464566
Name:EIBSCHUTZ, BARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:EIBSCHUTZ
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 1:1039 MURRARY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-2058
Mailing Address - Country:US
Mailing Address - Phone:805-781-0702
Mailing Address - Fax:888-225-4693
Practice Address - Street 1:1039 MURRARY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-2058
Practice Address - Country:US
Practice Address - Phone:805-781-0702
Practice Address - Fax:888-255-4693
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78005207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G780050Medicaid
CAG78005AMedicare PIN
CAG44801Medicare UPIN