Basic Information
| Provider Information | |||||||||
| NPI: | 1427037084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EICHENHOLZ | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650252 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752650252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178613994 | ||||||||
| FaxNumber: | 8178770350 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 E. LAMAR | ||||||||
| Address2: | 400 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888043000 | ||||||||
| FaxNumber: | 8178770350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G6715 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | G6715 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 131498108 | 05 | TX | MEDICAID |