Healthcare Provider Details

I. General information

NPI: 1063416048
Provider Name (Legal Business Name): ROBERT LAMAR EYSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S CLIFTON AVE
WICHITA KS
67218-2955
US

IV. Provider business mailing address

1131 S CLIFTON AVE
WICHITA KS
67218-2955
US

V. Phone/Fax

Practice location:
  • Phone: 316-858-1600
  • Fax: 316-858-1601
Mailing address:
  • Phone: 316-858-1600
  • Fax: 316-858-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15948
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: