Provider Demographics
NPI:1063485506
Name:CEITHAML, ERIC LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEE
Last Name:CEITHAML
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4047
Mailing Address - Country:US
Mailing Address - Phone:904-376-4083
Mailing Address - Fax:904-391-5075
Practice Address - Street 1:836 PRUDENTIAL DR STE 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8335
Practice Address - Country:US
Practice Address - Phone:904-202-8290
Practice Address - Fax:904-202-8171
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50651208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000367617AMedicaid
FL0457868-00Medicaid
FL02839UMedicare PIN
FL02389XMedicare PIN
FLD20791Medicare UPIN
FL0457868-00Medicaid
DC780000026Medicare PIN