Provider Demographics
NPI:1649223322
Name:ESPINA, EISEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:EISEN
Middle Name:J
Last Name:ESPINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5525 S STAPLES ST
Mailing Address - Street 2:E-2
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5370
Mailing Address - Country:US
Mailing Address - Phone:361-993-9500
Mailing Address - Fax:361-993-7933
Practice Address - Street 1:5525 S STAPLES ST
Practice Address - Street 2:E-2
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5370
Practice Address - Country:US
Practice Address - Phone:361-993-9500
Practice Address - Fax:361-993-7933
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137507305Medicaid
TXEH95Medicare ID - Type Unspecified
TXC15502Medicare UPIN