MEDICARE: MR. BRUCE SHELBY EICH II 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	208200000X	Plastic Surgery Physician	17710	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	43438	OTHER	THE OATH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	F78813	OTHER	VIVA
4	51505077	OTHER	BLUE CROSS
5	1310081	OTHER	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1477508091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE SHELBY EICH II MD

Provider Business Mailing Address
First Line	:	200 PILOT MEDICAL DRIVE
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3462
Country	:	US
Telephone Number	:	205-856-6155
Fax Number	:	205-856-9391

Provider Business Practice Location Address
First Line	:	200 PILOT MEDICAL DRIVE
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3462
Country	:	US
Telephone Number	:	205-856-6155
Fax Number	:	205-856-9391

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/19/2010

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