DR. JACK HENRY EBERHART MD NPI 1215969860

NPI Information

NPI: 1215969860
Provider Name: DR. JACK HENRY EBERHART, MD
Classification: Otolaryngology - 207YX0602X
Specialization: Otolaryngic Allergy
Entity Type: Individual
Address: 2300 E 30TH ST
BLDG D-102
FARMINGTON, NM
ZIP 87401
Phone: (505) 327-4429

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NPI Details

DR. Jack Henry Eberhart, MD is an otolaryngic allergy otolaryngology in Farmington, NM. The provider is an otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases. 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 9/11/2025.

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
1	207YX0007X	Otolaryngology	Plastic Surgery within the Head & Neck	97-223	NEW MEXICO	No
2	207YX0602X	Otolaryngology	Otolaryngic Allergy	97-223	NEW MEXICO	Yes

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
1	R7435	MEDICAID	NEW 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: 11/21/2025

NPI Synchronization or Removal

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