Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0 | TN |
Y | 213ES0000X | Sports Medicine | 0 | TN |
NPI | 1528633195 |
---|---|
Provider Name | Kody Eckert |
First Address | Sterling, KS 67579-2338 |
Second Address | Milligan College, TN 37682-3015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
236 | (05) | DC |