Provider Demographics
NPI:1629084694
Name:EICHOLD, BERNARD HERBERT II (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:HERBERT
Last Name:EICHOLD
Suffix:II
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:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-690-8853
Practice Address - Street 1:251 N BAYOU ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5827
Practice Address - Country:US
Practice Address - Phone:251-690-8158
Practice Address - Fax:251-690-8853
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011846OtherMEDICARE GROUP NUMBER
AL1063439065OtherSITE NPI MCARE GROUP PAYEE
AL1780864462OtherMOBILE COUNTY HEALTH DEPARTMENT SITE NPI NUMBER
AL631300009Medicaid
AL1780864462OtherMOBILE COUNTY HEALTH DEPARTMENT SITE NPI NUMBER