Provider Demographics
NPI:1841256773
Name:EIBLING, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:EIBLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1090
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1090
Mailing Address - Country:US
Mailing Address - Phone:209-334-0267
Mailing Address - Fax:209-334-1430
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:STE 2A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-466-8546
Practice Address - Fax:209-466-3335
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC40980207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C409800Medicaid
CA00C409800Medicare UPIN
CA00C409800Medicaid