Healthcare Provider Details

I. General information

NPI: 1164492823
Provider Name (Legal Business Name): LARRY STEVEN EISENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12670 CREEKSIDE LANE STE 202
FT MYERS FL
33919-8759
US

IV. Provider business mailing address

12670 CREEKSIDE LANE SUITE 202
FT MYERS FL
33919-8759
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-2663
  • Fax: 239-482-3106
Mailing address:
  • Phone: 239-482-2663
  • Fax: 239-482-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME0040040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: