Provider Demographics
NPI:1629033188
Name:EICHBERG, RODOLFO D (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:D
Last Name:EICHBERG
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 1:2914 N BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-1208
Mailing Address - Country:US
Mailing Address - Phone:813-228-7696
Mailing Address - Fax:813-228-0677
Practice Address - Street 1:2914 N BOULEVARD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-1208
Practice Address - Country:US
Practice Address - Phone:813-228-7696
Practice Address - Fax:813-228-0677
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022720208100000X, 202C00000X, 209800000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0690805-00Medicaid
FL205612OtherAVMED
FL2351293013OtherCIGNA
FL2306876OtherUNITED HEALTHCARE
FL29855OtherBLUE CROSS
FL4092884OtherAETNA
FL0690805-00Medicaid
FL4092884OtherAETNA