Provider Demographics
NPI:1699767772
Name:EISENACH, ROBERT JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFREY
Last Name:EISENACH
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 1:4202 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7841
Mailing Address - Country:US
Mailing Address - Phone:501-562-4838
Mailing Address - Fax:501-562-1958
Practice Address - Street 1:4202 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7841
Practice Address - Country:US
Practice Address - Phone:501-562-4838
Practice Address - Fax:501-562-1958
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51543OtherBLUE CROSS BLUE SHIELD
AR105086001Medicaid
AR11115000000OtherQUALCHOICE
AR120031OtherUNITED HEALTHCARE
AR11115000000OtherQUALCHOICE
AR51543Medicare ID - Type Unspecified