Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D7830 | AZ |
Y | 213EG0000X | General Practice | D7830 | AZ |
NPI | 1003046665 |
---|---|
Provider Name | Lonnie Chris Eckman |
First Address | Phoenix, AZ 85051-5770 |
Second Address | Phoenix, AZ 85051-5770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 16/07/2009 |