Basic Information
| Provider Information | |||||||||
| NPI: | 1033304415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | MSC 8064-37-1005 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143624211 | ||||||||
| FaxNumber: | 8883156494 | ||||||||
| Practice Location | |||||||||
| Address1: | 4901 FOREST PARK AVE | ||||||||
| Address2: | DIV OBGYN FAMILY PLANNING, STE 710 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631081495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143624211 | ||||||||
| FaxNumber: | 8883156494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2009004523 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | 2009004523 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 209352400 | 05 | MO | MEDICAID |