Organization
DEREK LEE EISNOR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK LEE EISNOR MD (OWNER/PRESIDENT)
(321) 254-6218
Entity
Organization
Contact information
Practice address
2080 W EAU GALLIE BLVD, MELBOURNE, FL 32935-3185
(321) 254-6218
(321) 254-6230
Mailing address
2080 W EAU GALLIE BLVD, MELBOURNE, FL 32935-3185
(321) 254-6218
(321) 254-6230
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
ME74231
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255900500
—
FL
Enumeration date
12/22/2008
Last updated
12/22/2008
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