Provider Demographics
NPI:1063416048
Name:EYSTER, ROBERT LAMAR (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LAMAR
Last Name:EYSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2955
Mailing Address - Country:US
Mailing Address - Phone:316-858-1600
Mailing Address - Fax:316-858-1601
Practice Address - Street 1:1131 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2955
Practice Address - Country:US
Practice Address - Phone:316-858-1600
Practice Address - Fax:316-858-1601
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15948207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100152180CMedicaid
KS200041418OtherRAILROAD MEDICARE PIN
KS100152180CMedicaid
KS4771810001Medicare NSC
KS110683Medicare PIN