Healthcare Provider Details

I. General information

NPI: 1902300569
Provider Name (Legal Business Name): JACOB V EISERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 SEVEN HILLS DR STE 103
HENDERSON NV
89052-4378
US

IV. Provider business mailing address

870 SEVEN HILLS DR STE 103
HENDERSON NV
89052-4378
US

V. Phone/Fax

Practice location:
  • Phone: 725-777-0414
  • Fax:
Mailing address:
  • Phone: 725-777-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number22614
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: