Provider Demographics
NPI:1164595922
Name:EISEMAN, ROBERT MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:EISEMAN
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 1:920 ESTATE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0601
Mailing Address - Country:US
Mailing Address - Phone:901-767-3620
Mailing Address - Fax:901-683-0285
Practice Address - Street 1:920 ESTATE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0601
Practice Address - Country:US
Practice Address - Phone:901-767-3620
Practice Address - Fax:901-683-0285
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04300772Medicaid
TNQ005992Medicaid
AR206449001Medicaid
TN6013571OtherBCBS
MS04300772Medicaid