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DR. JACK HENRY EBERHART MD NPI 1215969860


NPI Information

NPI: 1215969860
Provider Name: DR. JACK HENRY EBERHART, MD
Classification: Otolaryngology - 207YX0007X
Entity Type: Individual

Specialization: Plastic Surgery within the Head & Neck

Address:
2300 E 30TH ST
BLDG D-102
FARMINGTON, NM
ZIP 87401
Phone: (505) 327-4429
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DR. Jack Henry Eberhart, MD is a plastic surgery within the head and neck otolaryngology in Farmington, NM. The provider is an otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. DR. Jack Henry Eberhart, MD NPI is 1215969860. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2300 E 30TH ST
BLDG D-102
FARMINGTON, NM
ZIP 87401-990
Phone: (505) 327-4429
Fax: (505) 327-4420

The enumeration date for this NPI number is 7/6/2006 and was last updated on 7/8/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207YX0007XOtolaryngologyPlastic Surgery within the Head & Neck97-223NEW MEXICOYes
2207YX0602XOtolaryngologyOtolaryngic Allergy97-223NEW MEXICOX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R7435MEDICAIDNEW MEXICO
2B09651MEDICARE UPINNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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