Basic Information
| Provider Information | |||||||||
| NPI: | 1174937296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESHENRODER | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ESHENRODER | ||||||||
| OtherFirstName: | NATHAN | ||||||||
| OtherMiddleName: | MICHAEL | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 499 10TH ST. | ||||||||
| Address2: | |||||||||
| City: | FORESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303931300 | ||||||||
| FaxNumber: | 8303931301 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 DILWORTH PLAZA | ||||||||
| Address2: | |||||||||
| City: | POTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303931400 | ||||||||
| FaxNumber: | 8303931775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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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 | 207Q00000X | LL37111 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R4217 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.