Healthcare Provider Details

I. General information

NPI: 1871609966
Provider Name (Legal Business Name): LEO EDWARD EICKHOFF III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 COURT ST
REDDING CA
96001-2531
US

IV. Provider business mailing address

2147 COURT ST
REDDING CA
96001-2531
US

V. Phone/Fax

Practice location:
  • Phone: 530-243-8667
  • Fax: 530-243-8742
Mailing address:
  • Phone: 530-243-8667
  • Fax: 530-243-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG88920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: