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General NPI Number Information
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NPI Number | 1073820254
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Entity Type | Organization
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Legal Business Name | EICHELBERGER MEDICAL PRACTICE, P.A.
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 1610 JAMES BOWIE DRIVE SUITE A103
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City | BAYTOWN
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State | TX
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Zip | 77520-3346
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Country | US
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Telephone | 281-427-8502
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Fax | 281-420-5575
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Provider Business Mailing Address
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Address Line | 1610 JAMES BOWIE DRIVE SUITE A103
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City | BAYTOWN
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State | TX
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Zip | 77520-3346
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Country | US
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Telephone | 281-427-8502
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Fax | 281-420-5575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP THEODRIC EICHELBERGER JR.
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Credential | M.D.
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Telephone | 281-427-8502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C6308
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License Number State | TX
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