Basic Information
| Provider Information | |||||||||
| NPI: | 1184902140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EYTING | ||||||||
| FirstName: | KLAUS | ||||||||
| MiddleName: | FRIEDEMANN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EYTING | ||||||||
| OtherFirstName: | KLAUS | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ATP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1104 W 34TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124584589 | ||||||||
| FaxNumber: | 5124549521 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 W 34TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124584589 | ||||||||
| FaxNumber: | 5124549521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2011 | ||||||||
| LastUpdateDate: | 07/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | 74-2556119 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.