Provider Demographics
NPI:1558453043
Name:EICHER, DAVID THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THEODORE
Last Name:EICHER
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 1:5148 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4044
Mailing Address - Country:US
Mailing Address - Phone:602-952-9962
Mailing Address - Fax:
Practice Address - Street 1:5148 N 18TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4044
Practice Address - Country:US
Practice Address - Phone:602-952-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5101207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ205048-02Medicaid
AZ205048-02Medicaid