MEDICARE: DOUGLAS EISENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD17783	OR

General Provider Information

NPI Number	:	1558345355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS EISENBERG MD

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2023
Country	:	US
Telephone Number	:	503-813-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	KAISER SUNNYSIDE MEDICAL CENTER
Second Line	:	10180 SE SUNNYSIDE RD
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-9764
Country	:	US
Telephone Number	:	503-813-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/16/2007

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