Basic Information
| Provider Information | |||||||||
| NPI: | 1619985629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPPICH | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 INDEPENDENCE PKWY | ||||||||
| Address2: | #203 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725969511 | ||||||||
| FaxNumber: | 9728678163 | ||||||||
| Practice Location | |||||||||
| Address1: | 8080 INDEPENDENCE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750254002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725969511 | ||||||||
| FaxNumber: | 9728678163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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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 | 207Q00000X | L4365 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.