Derek Lee Eisnor MD PA

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

ME74231 Issued in FL

Legal business name

DEREK LEE EISNOR MD PA

Practice address

2080 W Eau Gallie Blvd
Melbourne, FL 32935-3185

Phone

(321) 254-6218

Fax

(321) 254-6230

NPI assigned

Dec 22, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Derek Lee Eisnor, MD

Title

Owner/President

Phone

(321) 254-6218

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229904000000",
    "number": "1508002544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 W EAU GALLIE BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353185",
            "telephone_number": "321-254-6218",
            "fax_number": "321-254-6230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 W EAU GALLIE BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353185",
            "telephone_number": "321-254-6218",
            "fax_number": "321-254-6230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK LEE EISNOR MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2008-12-22",
        "status": "A",
        "authorized_official_last_name": "EISNOR",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "321-254-6218",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "FL",
            "license": "ME74231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255900500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medical Services (Emergency Medicine) Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.