Provider Demographics
NPI:1730165101
Name:HIRSCH, ERIC W (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1990
Mailing Address - Country:US
Mailing Address - Phone:352-746-2663
Mailing Address - Fax:352-746-6907
Practice Address - Street 1:950 N AVALON WAY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-6004
Practice Address - Country:US
Practice Address - Phone:352-746-2663
Practice Address - Fax:352-746-6907
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057649207X00000X
FLME95650207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000710700Medicaid
VA006406505Medicaid
FL56624OtherBLUE CROSS BLUE SHIELD
FLAF761YMedicare PIN
FL56624OtherBLUE CROSS BLUE SHIELD
VA006406505Medicaid