Provider Demographics
NPI:1881671261
Name:EISEN, BARRY R (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:EISEN
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 1:1725 E 19TH ST
Mailing Address - Street 2:STE 600
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5424
Mailing Address - Country:US
Mailing Address - Phone:918-749-3939
Mailing Address - Fax:918-748-7548
Practice Address - Street 1:1725 E 19TH ST
Practice Address - Street 2:STE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5424
Practice Address - Country:US
Practice Address - Phone:918-749-3939
Practice Address - Fax:918-748-7548
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13104207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10011920AMedicaid
OK020020933OtherRAILROAD MEDICARE
OK10011920AMedicaid