Provider Demographics
NPI:1275511420
Name:EISMAN, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:EISMAN
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 1:681 ENCINITAS BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3762
Mailing Address - Country:US
Mailing Address - Phone:760-632-4269
Mailing Address - Fax:760-632-4256
Practice Address - Street 1:354 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5142
Practice Address - Country:US
Practice Address - Phone:760-943-8806
Practice Address - Fax:790-943-8806
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54742207RP1001X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547420Medicaid
CAWG54742FMedicare PIN
CAA93316Medicare UPIN
CA00G547420Medicaid
CAWG54742FMedicare ID - Type Unspecified