Healthcare Provider Details

I. General information

NPI: 1285699645
Provider Name (Legal Business Name): DAVID J. ESCHELBACHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 N 22ND ST
TAMPA FL
33605-2762
US

IV. Provider business mailing address

PO BOX 9155
TAMPA FL
33674-9155
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2494
  • Fax: 813-374-2495
Mailing address:
  • Phone: 813-374-2494
  • Fax: 813-374-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME89859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: