Provider Demographics
NPI:1467690552
Name:LAWRENCE D EISENHAUER MD INC LAWRENCE D EISENHAUER M D OFFICER
Entity Type:Organization
Organization Name:LAWRENCE D EISENHAUER MD INC LAWRENCE D EISENHAUER M D OFFICER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EISENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-753-8413
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-753-8413
Mailing Address - Fax:760-753-5351
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE LL4
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-753-8413
Practice Address - Fax:760-753-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083773246OtherTYPE 1 NPI