Basic Information
| Provider Information | |||||||||
| NPI: | 1558379578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EICH | ||||||||
| FirstName: | WILBUR | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 BRECKENRIDGE CT | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356306650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562460580 | ||||||||
| FaxNumber: | 2562460581 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 MARENGO ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356306033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567689191 | ||||||||
| FaxNumber: | 2562460581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 04/08/2008 | ||||||||
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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 | 208000000X | 3765 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 207P00000X | MD.3765 | AL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4114623 | 01 | AL | AETNA | OTHER |