Provider Demographics
NPI:1821015843
Name:EYER, AUBREY GLENN (MD)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:GLENN
Last Name:EYER
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 1:1056 VIA FORTUNA
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1820
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-396-0851
Practice Address - Street 1:35800 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1739
Practice Address - Country:US
Practice Address - Phone:760-834-8306
Practice Address - Fax:760-834-8306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22526207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G225260Medicaid
CA00G225260OtherBLUE SHIELD
CAAY755AMedicare PIN
CA00G225260Medicaid
CA00G225260OtherBLUE SHIELD
CA00G225260Medicare PIN