Provider Demographics
NPI:1720838899
Name:FROST-EISENBERG, CODY CARVER
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:CARVER
Last Name:FROST-EISENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33172 MALARKEY LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-7110
Mailing Address - Country:US
Mailing Address - Phone:310-775-1236
Mailing Address - Fax:
Practice Address - Street 1:709 MALL BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4805
Practice Address - Country:US
Practice Address - Phone:912-201-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program