Provider Demographics
NPI:1144259656
Name:EISENBAUM, ALLAN M (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:M
Last Name:EISENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:STE 2A100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-7217
Practice Address - Country:US
Practice Address - Phone:806-743-2020
Practice Address - Fax:806-743-1782
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS22433207W00000X
TX44326207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS13883OtherPHS
KS53746872OtherMULTIPLAN
KS100198520BMedicaid
KS650862OtherBCBS
KS119954OtherCOVENTRY
TX196320901Medicaid
KS205163OtherHPK
TX8L2134Medicare PIN
KS650862OtherBCBS
TX196320901Medicaid