Provider Demographics
NPI:1558379578
Name:EICH, WILBUR F (MD)
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:F
Last Name:EICH
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 1:207 BRECKENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6650
Mailing Address - Country:US
Mailing Address - Phone:256-246-0580
Mailing Address - Fax:256-246-0581
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6033
Practice Address - Country:US
Practice Address - Phone:256-768-9191
Practice Address - Fax:256-246-0581
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3765208000000X
ALMD.3765207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4114623OtherAETNA
AL4114623OtherAETNA