MEDICARE: DAVID L EIBLING M.D.

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	207V00000X	Obstetrics & Gynecology Physician	C40980	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841256773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L EIBLING M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 1090
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95241-1090
Country	:	US
Telephone Number	:	209-334-0267
Fax Number	:	209-334-1430

Provider Business Practice Location Address
First Line	:	1617 N CALIFORNIA ST
Second Line	:	STE 2A
City	:	STOCKTON
State	:	CA
Zip	:	95204-6117
Country	:	US
Telephone Number	:	209-466-8546
Fax Number	:	209-466-3335

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/04/2016

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Directions to “ DAVID L EIBLING M.D.” Practice Location

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