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NPI Code Detail

MEDICARE: NANCY J EISEN DO

MEDICARE: NANCY J EISEN DO
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
1207Q00000XFamily Medicine PhysicianK5519TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00770770OTHERTXRRMCR
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629136387
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY J EISEN DO
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 1507 RIVERY BLVD
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-3058
Country : US
Telephone Number : 512-509-9550
Fax Number : 512-509-9555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 05/11/2022

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