Provider Demographics
NPI:1245267764
Name:FUTSCHER, ERIC R (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:FUTSCHER
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 1:1600 W COLLEGE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3575
Mailing Address - Country:US
Mailing Address - Phone:817-912-0442
Mailing Address - Fax:817-329-5668
Practice Address - Street 1:1600 W COLLEGE ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3575
Practice Address - Country:US
Practice Address - Phone:817-912-0442
Practice Address - Fax:817-329-5668
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160499302Medicaid
TX160499301Medicaid
TX160499302Medicaid
TX8K9755Medicare PIN
TX8A9140Medicare PIN