Provider Demographics
NPI:1932107323
Name:EISENMAN, RICHARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:EISENMAN
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 1:5065 STATE ROAD 7
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4615
Mailing Address - Country:US
Mailing Address - Phone:561-753-7487
Mailing Address - Fax:561-753-8161
Practice Address - Street 1:5065 STATE ROAD 7
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-4615
Practice Address - Country:US
Practice Address - Phone:561-753-7487
Practice Address - Fax:561-753-8161
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064516207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374484100Medicaid
23494OtherBC/BS
FL374484100Medicaid
23494Medicare ID - Type Unspecified