Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 15306 | WV |
NPI | 1023118825 |
---|---|
Provider Name | Dr. John M Eckerd |
First Address | Charleston, WV 25302-3302 |
Second Address | Charleston, WV 25302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 03/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105677000 | (05) | WV |
A72556 | (02) |