Provider Demographics
NPI:1114238839
Name:EHLE, ERIC C (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:EHLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4137
Mailing Address - Country:US
Mailing Address - Phone:806-355-9355
Mailing Address - Fax:806-340-7975
Practice Address - Street 1:11 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4137
Practice Address - Country:US
Practice Address - Phone:806-355-9355
Practice Address - Fax:806-340-7975
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200496900 AMedicaid
NM88286878Medicaid
TX324154901Medicaid
NM88286878Medicaid