Provider Demographics
NPI:1619985629
Name:EPPICH, KEITH RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:RYAN
Last Name:EPPICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:#203
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023
Mailing Address - Country:US
Mailing Address - Phone:972-596-9511
Mailing Address - Fax:972-867-8163
Practice Address - Street 1:8080 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4002
Practice Address - Country:US
Practice Address - Phone:972-596-9511
Practice Address - Fax:972-867-8163
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0433Medicare PIN
H45342Medicare UPIN