Provider Demographics
NPI:1871674333
Name:EISAN, LEE BRETT (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:BRETT
Last Name:EISAN
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 1:907 SAN RAMON VALLEY BLVD # 102
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526
Mailing Address - Country:US
Mailing Address - Phone:925-837-7409
Mailing Address - Fax:925-837-5821
Practice Address - Street 1:907 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE # 102
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526
Practice Address - Country:US
Practice Address - Phone:925-837-7409
Practice Address - Fax:925-837-5821
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G37664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47184Medicare UPIN
CA00G37664Medicare ID - Type Unspecified