Healthcare Provider Details

I. General information

NPI: 1881993046
Provider Name (Legal Business Name): ANDREW JACOBS EYRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2011
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST DEPT. OF EMERGENCY MEDICINE
BOSTON MA
02115-6110
US

IV. Provider business mailing address

59 CLAYPIT HILL RD
WAYLAND MA
01778-2004
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8070
  • Fax:
Mailing address:
  • Phone: 508-243-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number261499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: