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1063488757

NPI Code Detail

MEDICARE: JAMES M. EIDEL MD

MEDICARE: JAMES M. EIDEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	99-39	NM
2	207L00000X	Anesthesiology Physician	G202421	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050067169	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NM009D28	OTHER	NM	BCBS OF NM

General Provider Information

NPI Number	:	1063488757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M. EIDEL MD

Provider Business Mailing Address
First Line	:	150 PIONEER LN
Second Line	:
City	:	BISHOP
State	:	CA
Zip	:	93514-2556
Country	:	US
Telephone Number	:	760-873-5811
Fax Number	:	760-872-5843

Provider Business Practice Location Address
First Line	:	150 PIONEER LN
Second Line	:
City	:	BISHOP
State	:	CA
Zip	:	93514-2556
Country	:	US
Telephone Number	:	760-873-5811
Fax Number	:	760-872-5843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/13/2025

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Directions to “ JAMES M. EIDEL MD” Practice Location

Language	Start Address	Practice Location

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