Individual
JERRY D. EISNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E. KINCAID ST., SKAGIT REGIONAL CLINICS, MOUNT VERNON, WA 98274-4127
(360) 814-6200
(360) 814-6210
Mailing address
1400 E. KINCAID ST., ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD00014819
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263627
LABOR & INDUSTRIES
WA
05
—
8354912
—
WA
Enumeration date
09/23/2005
Last updated
10/05/2012
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