Basic Information
| Provider Information | |||||||||
| NPI: | 1609260777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EYBERG | ||||||||
| FirstName: | BLAKE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 10TH ST SE STE 140 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193981545 | ||||||||
| FaxNumber: | 8776713861 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 10TH ST SE STE 140 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193981545 | ||||||||
| FaxNumber: | 8776713861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME143692 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | MD-48531 | 01 | IA | IOWA LICENSE | OTHER |