Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0418105 | KS |
NPI | 1225089733 |
---|---|
Provider Name | Robert David Ecklund |
First Address | Manhattan, KS 66502-3761 |
Second Address | Manhattan, KS 66502-3761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |