Provider Demographics
NPI:1447352422
Name:EICHER, DENNIS MARVIN (D O)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MARVIN
Last Name:EICHER
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CASTLE VALLEY BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9453
Mailing Address - Country:US
Mailing Address - Phone:970-984-0651
Mailing Address - Fax:970-984-0402
Practice Address - Street 1:820 CASTLE VALLEY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-9453
Practice Address - Country:US
Practice Address - Phone:970-984-0651
Practice Address - Fax:970-984-0402
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01224278Medicaid
EI198728OtherBCBS INDIVIDUAL
COEI198728OtherBCBS INDIVIDUAL #
EI198728OtherBCBS INDIVIDUAL
COEI198728OtherBCBS INDIVIDUAL #
CO393518Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
CO01224278Medicaid