Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 54452 | WI |
NPI | 1013189737 |
---|---|
Provider Name | Gerald William Eckardt |
First Address | Green Bay, WI 54303-2728 |
Second Address | Green Bay, WI 54311-6519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 11/07/2016 |