Provider Demographics
NPI:1477508091
Name:EICH, BRUCE SHELBY II (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:SHELBY
Last Name:EICH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:200 PILOT MEDICAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3462
Mailing Address - Country:US
Mailing Address - Phone:205-856-6155
Mailing Address - Fax:205-856-9391
Practice Address - Street 1:200 PILOT MEDICAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3462
Practice Address - Country:US
Practice Address - Phone:205-856-6155
Practice Address - Fax:205-856-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL17710208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
43438OtherTHE OATH
AL009975650Medicaid
F78813OtherVIVA
51505077OtherBLUE CROSS
1310081OtherUNITED HEALTHCARE
F78813OtherVIVA
AL009975650Medicaid