Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2040 | WV |
NPI | 1043389265 |
---|---|
Provider Name | Dr. L. Edward Eckley |
First Address | Beckley, WV 25801-3331 |
Second Address | Beckley, WV 25801-3331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0137774000 | (05) | WV |
0550596553 | FEDERAL ID NUMBER (01) | WV |