Provider Demographics
NPI:1720281330
Name:EISENHAUER, DAVID EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:EISENHAUER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY STE 430
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-556-8757
Mailing Address - Fax:417-556-8758
Practice Address - Street 1:100 MERCY WAY STE 430
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-8757
Practice Address - Fax:417-556-8758
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76704207X00000X
OK4402207X00000X
NVDO1632207X00000X, 207XS0106X
FLOS11124207X00000X
CA20A11979207X00000X, 207XS0106X
MO2017043630207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14A69OtherBC/BS
FL003190200Medicaid
FL9308573OtherAETNA
FL9410607OtherCIGNA
FL003190200Medicaid