Provider Demographics
NPI:1457631129
Name:EILERS, BRENT (CCP, CSA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:EILERS
Suffix:
Gender:M
Credentials:CCP, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14603 HUEBNER RD
Mailing Address - Street 2:BLD 28 STE 28101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5469
Mailing Address - Country:US
Mailing Address - Phone:210-614-7074
Mailing Address - Fax:210-614-7091
Practice Address - Street 1:14603 HUEBNER RD
Practice Address - Street 2:BLD 28 STE 2801
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5469
Practice Address - Country:US
Practice Address - Phone:210-614-7074
Practice Address - Fax:210-614-7091
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4164246ZC0007X
TXFPF00000470242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant