Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | H4300 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | H4300 | TX |
NPI | 1124024765 |
---|---|
Provider Name | Dr. Terri Lynn Eckert |
First Address | Dallas, TX 75284-6098 |
Second Address | Athens, TX 75751-8950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 19/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139011401 | (05) | TX |
139011413 | (05) | TX |
75-2616977-029 | TRICARE (01) | |
E32570 | (02) | TX |