Provider Demographics
NPI:1497782130
Name:EITNER, JAMES WILLIAM (DO, MED, FACOFP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:EITNER
Suffix:
Gender:M
Credentials:DO, MED, FACOFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 S PRIEST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6204
Mailing Address - Country:US
Mailing Address - Phone:480-921-2273
Mailing Address - Fax:480-921-7114
Practice Address - Street 1:1626 S PRIEST DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6204
Practice Address - Country:US
Practice Address - Phone:480-921-2273
Practice Address - Fax:480-921-7114
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133424Medicare UPIN
AZZ126048Medicare PIN
AZZ133425Medicare UPIN
AZZ120952Medicare PIN