Healthcare Provider Details

I. General information

NPI: 1306232285
Provider Name (Legal Business Name): TODD WALTER EICHELBERGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SW 8TH ST
OCALA FL
34471-0951
US

IV. Provider business mailing address

111 SW 8TH ST
OCALA FL
34471-0951
US

V. Phone/Fax

Practice location:
  • Phone: 352-619-0029
  • Fax:
Mailing address:
  • Phone: 352-619-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS14881
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: