Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01083875A | IN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 01083875A | IN |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 85433 | SC |
NPI | 1093100844 |
---|---|
Provider Name | Dr. Christian Joseph Eccles |
First Address | Conway, SC 29526-9142 |
Second Address | Conway, SC 29526-8945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 20/07/2021 |